Provider Demographics
NPI:1942052345
Name:COLON, CELINE LOURDES (MHC-LP)
Entity Type:Individual
Prefix:
First Name:CELINE
Middle Name:LOURDES
Last Name:COLON
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15632 71ST AVE APT 30A
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2244
Mailing Address - Country:US
Mailing Address - Phone:347-299-6617
Mailing Address - Fax:
Practice Address - Street 1:2499 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1396
Practice Address - Country:US
Practice Address - Phone:516-640-6788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health