Provider Demographics
NPI:1831575943
Name:COLONNA, PAULINA (LMFT)
Entity type:Individual
Prefix:
First Name:PAULINA
Middle Name:
Last Name:COLONNA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1941
Mailing Address - Country:US
Mailing Address - Phone:570-332-2675
Mailing Address - Fax:
Practice Address - Street 1:1248 W MAIN ST
Practice Address - Street 2:SUITE 25
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1311
Practice Address - Country:US
Practice Address - Phone:570-332-2675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000841106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist