Provider Demographics
NPI:1992371280
Name:ITZKOWITZ, COLLEEN ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANN
Last Name:ITZKOWITZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-3202
Mailing Address - Country:US
Mailing Address - Phone:631-252-3153
Mailing Address - Fax:
Practice Address - Street 1:689 E JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-7501
Practice Address - Country:US
Practice Address - Phone:631-854-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108846-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker