Healthcare Provider Details

I. General information

NPI: 1275525180
Provider Name (Legal Business Name): CAROL A. COLBY LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 DELAWARE AVE
DELMAR NY
12054-1227
US

IV. Provider business mailing address

402 UNION ST
SCHENECTADY NY
12305-1119
US

V. Phone/Fax

Practice location:
  • Phone: 518-439-0033
  • Fax: 518-439-7167
Mailing address:
  • Phone: 518-374-7555
  • Fax: 518-374-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberR051293
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7196
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number29
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: