MEDICARE: MRS. ROBERTA KOLODNY MSW

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	101YM0800X	Mental Health Counselor	R030229-1	NY

General Provider Information

NPI Number	:	1700819851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROBERTA KOLODNY MSW

Provider Business Mailing Address
First Line	:	21 HEREFORD RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11020-1712
Country	:	US
Telephone Number	:	516-482-4740
Fax Number	:	516-482-3124

Provider Business Practice Location Address
First Line	:	21 HEREFORD RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11020-1712
Country	:	US
Telephone Number	:	516-482-4740
Fax Number	:	516-482-3124

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/09/2007

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