Healthcare Provider Details

I. General information

NPI: 1821567520
Provider Name (Legal Business Name): VALENTINA COLON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98120 QUEENS BLVD
REGO PARK NY
11374-4357
US

IV. Provider business mailing address

98120 QUEENS BLVD
REGO PARK NY
11374-4357
US

V. Phone/Fax

Practice location:
  • Phone: 347-940-8601
  • Fax:
Mailing address:
  • Phone: 718-830-0246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number103342
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: