Provider Demographics
NPI:1720442551
Name:NERNEY, COLLEEN
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:NERNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:MULLADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:P.O. BOX 1094
Mailing Address - Street 2:102 MAIN STREET
Mailing Address - City:HANCOCK
Mailing Address - State:MA
Mailing Address - Zip Code:01267
Mailing Address - Country:US
Mailing Address - Phone:518-265-9336
Mailing Address - Fax:
Practice Address - Street 1:102 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MA
Practice Address - Zip Code:01237
Practice Address - Country:US
Practice Address - Phone:518-265-9336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1153461041C0700X
MELC149271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical