Healthcare Provider Details

I. General information

NPI: 1538230057
Provider Name (Legal Business Name): FRANCES COLON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WAVE AVE
MEDFORD NY
11763-1772
US

IV. Provider business mailing address

111 SHINNECOCK AVENUE
MASTIC NY
11950-2815
US

V. Phone/Fax

Practice location:
  • Phone: 631-687-8165
  • Fax:
Mailing address:
  • Phone: 617-905-3659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number213033
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number213033
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: