Healthcare Provider Details

I. General information

NPI: 1659992345
Provider Name (Legal Business Name): TAYLOR MARIE COLBERT LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 BOICEVILLE RD
BROOKTONDALE NY
14817-9571
US

IV. Provider business mailing address

455 BOICEVILLE RD
BROOKTONDALE NY
14817-9571
US

V. Phone/Fax

Practice location:
  • Phone: 917-715-4452
  • Fax:
Mailing address:
  • Phone: 917-715-4452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number011832
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: