Provider Demographics
NPI:1801935010
Name:CANYON, COLLEEN H (LCSW)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:H
Last Name:CANYON
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 MOUNTAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087
Mailing Address - Country:US
Mailing Address - Phone:917-881-8096
Mailing Address - Fax:
Practice Address - Street 1:220 9TH ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4288
Practice Address - Country:US
Practice Address - Phone:929-992-0935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0988371041C0700X
NJ25MZ00019300171100000X
NY001473171100000X
NJ44SC063739001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171100000XOther Service ProvidersAcupuncturist