Provider Demographics
NPI:1669205407
Name:COLLEY, RAYMOND LOUIS
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:LOUIS
Last Name:COLLEY
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 1:61 WEST ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1726
Mailing Address - Country:US
Mailing Address - Phone:585-610-9368
Mailing Address - Fax:
Practice Address - Street 1:61 WEST ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1726
Practice Address - Country:US
Practice Address - Phone:585-610-9368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No252Y00000XAgenciesEarly Intervention Provider Agency