MEDICARE: MR. RICHARD S. COLLIE LCSW-R

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	080045-1	NY
2	1041C0700X	Clinical Social Worker	R-080045-1	NY

General Provider Information

NPI Number	:	1083767412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD S. COLLIE LCSW-R

Provider Business Mailing Address
First Line	:	716 OCEAN AVE
Second Line	:	#19
City	:	BROOKLYN
State	:	NY
Zip	:	11226-5383
Country	:	US
Telephone Number	:	917-232-7259
Fax Number	:	718-709-7471

Provider Business Practice Location Address
First Line	:	12 W 9TH ST # 1B2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-8905
Country	:	US
Telephone Number	:	917-232-7259
Fax Number	:	718-709-7471

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	05/15/2024

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Directions to “ MR. RICHARD S. COLLIE LCSW-R” Practice Location

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