Provider Demographics
NPI:1821462953
Name:COLON, MIGDALIA (MCH-LP)
Entity type:Individual
Prefix:
First Name:MIGDALIA
Middle Name:
Last Name:COLON
Suffix:
Gender:F
Credentials:MCH-LP
Other - Prefix:
Other - First Name:MIGDALIA
Other - Middle Name:
Other - Last Name:CARRION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 MALTESE DR STE 404
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2141
Mailing Address - Country:US
Mailing Address - Phone:845-342-4774
Mailing Address - Fax:
Practice Address - Street 1:419 E MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2552
Practice Address - Country:US
Practice Address - Phone:845-281-7190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18-P130645101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health