Healthcare Provider Details

I. General information

NPI: 1316531098
Provider Name (Legal Business Name): CHRISTINA BARBARA COLON LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 07/29/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 STEWART AVE STE 100
BETHPAGE NY
11714-1601
US

IV. Provider business mailing address

165 N VILLAGE AVE
ROCKVILLE CENTRE NY
11570-3761
US

V. Phone/Fax

Practice location:
  • Phone: 516-465-3998
  • Fax:
Mailing address:
  • Phone: 516-442-1116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number010660
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: