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NPI Code Detail

MEDICARE: MRS. ALYSE FREDA-COLON LCSW

MEDICARE: MRS. ALYSE FREDA-COLON LCSW
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
11041C0700XClinical Social WorkerR048909-1NY

General Provider Information

NPI Number : 1497706014
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ALYSE FREDA-COLON LCSW
Provider Business Mailing Address
First Line : 15 WOODRUFF CT
Second Line :
City : HUNTINGTON
State : NY
Zip : 11743-2355
Country : US
Telephone Number : 631-271-0712
Fax Number :
Provider Business Practice Location Address
First Line : 410 E MAIN ST
Second Line :
City : CENTERPORT
State : NY
Zip : 11721-1541
Country : US
Telephone Number : 516-635-4848
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 07/08/2007

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