Healthcare Provider Details

I. General information

NPI: 1508215278
Provider Name (Legal Business Name): COLEY C WOODWARD II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 2ND AVE RM 102
NEW YORK NY
10128-5363
US

IV. Provider business mailing address

49 W JERICHO TPKE # 1007
HUNTINGTON STATION NY
11746-3603
US

V. Phone/Fax

Practice location:
  • Phone: 408-620-4040
  • Fax:
Mailing address:
  • Phone: 408-620-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: