Healthcare Provider Details

I. General information

NPI: 1538853882
Provider Name (Legal Business Name): HILARY MARY COLENSO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PLUMMER RD
SANBORNTON NH
03269-2358
US

IV. Provider business mailing address

PO BOX 64
SANBORNTON NH
03269-0064
US

V. Phone/Fax

Practice location:
  • Phone: 646-284-1797
  • Fax:
Mailing address:
  • Phone: 646-284-1797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR050902
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: