Healthcare Provider Details

I. General information

NPI: 1063338580
Provider Name (Legal Business Name): TODD RAYMOND COLVIN LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 COURT ST STE 1002
BROOKLYN NY
11242-1110
US

IV. Provider business mailing address

26 COURT ST STE 1002
BROOKLYN NY
11242-1110
US

V. Phone/Fax

Practice location:
  • Phone: 347-309-6870
  • Fax:
Mailing address:
  • Phone: 347-309-6870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: