Healthcare Provider Details

I. General information

NPI: 1194860437
Provider Name (Legal Business Name): PATRICIA ARLENE COLLEARY L.M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 MONTAUK HWY # 2
OAKDALE NY
11769-1434
US

IV. Provider business mailing address

15 JEFFERSON AVE
EAST ISLIP NY
11730-1141
US

V. Phone/Fax

Practice location:
  • Phone: 631-218-1545
  • Fax: 631-218-2650
Mailing address:
  • Phone: 631-277-1523
  • Fax: 631-277-1524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number061846-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: