Healthcare Provider Details

I. General information

NPI: 1033890009
Provider Name (Legal Business Name): COLLEEN CRAIG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 MADISON AVE # 15011
NEW YORK NY
10016-5101
US

IV. Provider business mailing address

40 GLADSTONE COURT
WHIPPANY NJ
07981
US

V. Phone/Fax

Practice location:
  • Phone: 406-361-3146
  • Fax:
Mailing address:
  • Phone: 973-876-0383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37PC01290700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: