Healthcare Provider Details

I. General information

NPI: 1356638589
Provider Name (Legal Business Name): MAUREEN ANNE COLLIGAN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 CENTER ST
MIDDLETOWN NY
10940-5704
US

IV. Provider business mailing address

2849 E PINE ST # 8
DEMING NM
88030-8618
US

V. Phone/Fax

Practice location:
  • Phone: 845-343-7675
  • Fax: 845-343-2501
Mailing address:
  • Phone: 575-543-9136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0203321
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0203321
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: