Provider Demographics
NPI:1952925018
Name:C PHILIP COLOSIMO PH D & ASSOCIATES LTD
Entity Type:Organization
Organization Name:C PHILIP COLOSIMO PH D & ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:COLOSIMO
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:702-384-7433
Mailing Address - Street 1:501 S RANCHO DR STE C14
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4831
Mailing Address - Country:US
Mailing Address - Phone:702-384-7433
Mailing Address - Fax:702-366-1204
Practice Address - Street 1:501 S RANCHO DR STE C14
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4831
Practice Address - Country:US
Practice Address - Phone:702-384-7433
Practice Address - Fax:702-366-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty