MEDICARE: MIGDALIA COLON MCH-LP

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	101YM0800X	Mental Health Counselor	18-P130645	NY

General Provider Information

NPI Number	:	1821462953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGDALIA COLON MCH-LP

Provider Business Mailing Address
First Line	:	111 MALTESE DR STE 404
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-2141
Country	:	US
Telephone Number	:	845-342-4774
Fax Number	:

Provider Business Practice Location Address
First Line	:	419 E MAIN ST STE 302
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-2552
Country	:	US
Telephone Number	:	845-281-7190
Fax Number	:

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

Provider Enumeration Date	:	12/01/2015
Last Update Date	:	11/15/2024

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