MEDICARE: MS. DENISE MARIE COLON LCSW-R

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R073347-01	NY

General Provider Information

NPI Number	:	1366388175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE MARIE COLON LCSW-R

Provider Business Mailing Address
First Line	:	110 W 94TH ST APT 3A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-7018
Country	:	US
Telephone Number	:	917-685-6588
Fax Number	:	917-685-6588

Provider Business Practice Location Address
First Line	:	110 W 94TH ST APT 3A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-7018
Country	:	US
Telephone Number	:	917-685-6588
Fax Number	:	917-685-6588

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2026
Last Update Date	:	04/24/2026

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