Provider Demographics
NPI:1700202439
Name:JAMRON, COLIN
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:JAMRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 TAAFFE PL
Mailing Address - Street 2:1L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1493
Mailing Address - Country:US
Mailing Address - Phone:774-364-1000
Mailing Address - Fax:
Practice Address - Street 1:36 PLAZA ST E
Practice Address - Street 2:1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-5048
Practice Address - Country:US
Practice Address - Phone:774-364-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005792101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health