Healthcare Provider Details

I. General information

NPI: 1619371705
Provider Name (Legal Business Name): COLLEEN PERRONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 PHELPS LN
NORTH BABYLON NY
11703-4005
US

IV. Provider business mailing address

180 E MAIN ST STE 205H
PATCHOGUE NY
11772-3171
US

V. Phone/Fax

Practice location:
  • Phone: 631-422-7676
  • Fax:
Mailing address:
  • Phone: 631-438-1570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number086717
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number092635
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: