MEDICARE: DR. COLLEEN SUSAN COLBERT PSYD

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	103T00000X	Psychologist	0107051	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	029692	OTHER	NY	VALUE OPTIONS
2	P1024855	OTHER	NY	GHI

General Provider Information

NPI Number	:	1558581652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLLEEN SUSAN COLBERT PSYD

Provider Business Mailing Address
First Line	:	105 SHAD ROW
Second Line	:	SUITE D
City	:	PIERMONT
State	:	NY
Zip	:	10968
Country	:	US
Telephone Number	:	845-398-8864
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 SHAD ROW
Second Line	:	SUITE D
City	:	PIERMONT
State	:	NY
Zip	:	10968
Country	:	US
Telephone Number	:	845-398-8864
Fax Number	:

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

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	07/08/2007

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