Healthcare Provider Details

I. General information

NPI: 1013879618
Provider Name (Legal Business Name): COLLEEN ROSE MULREADY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 S CHESTNUT ST
NEW PALTZ NY
12561-1943
US

IV. Provider business mailing address

144 ALDA DR
KINGSTON NY
12401-8700
US

V. Phone/Fax

Practice location:
  • Phone: 845-533-5125
  • Fax:
Mailing address:
  • Phone: 845-309-2791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number076687-11
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: