Healthcare Provider Details

I. General information

NPI: 1225904170
Provider Name (Legal Business Name): COLLYNDA HUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 BERRY ST
BROOKLYN NY
11249-6084
US

IV. Provider business mailing address

390 BERRY ST
BROOKLYN NY
11249-6084
US

V. Phone/Fax

Practice location:
  • Phone: 646-571-8270
  • Fax:
Mailing address:
  • Phone: 646-571-8270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number009005
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: