Provider Demographics
NPI:1700819851
Name:KOLODNY, ROBERTA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:
Last Name:KOLODNY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HEREFORD RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11020-1712
Mailing Address - Country:US
Mailing Address - Phone:516-482-4740
Mailing Address - Fax:516-482-3124
Practice Address - Street 1:21 HEREFORD RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11020-1712
Practice Address - Country:US
Practice Address - Phone:516-482-4740
Practice Address - Fax:516-482-3124
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR030229-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNH3702Medicare UPIN