Provider Demographics
NPI:1821543596
Name:COLACE, STEPHANIE (LMHC, NCC, CRC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:COLACE
Suffix:
Gender:F
Credentials:LMHC, NCC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 BELLEROSE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1621
Mailing Address - Country:US
Mailing Address - Phone:917-613-7780
Mailing Address - Fax:
Practice Address - Street 1:222 BELLEROSE AVE
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1621
Practice Address - Country:US
Practice Address - Phone:917-613-7780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006786-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health