MEDICARE: MICHAEL COLLERAN MT-BC

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	225A00000X	Music Therapist	16213

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16213	OTHER		CERTIFICATION BOARD OF MUSIC THERAPISTS ID #

General Provider Information

NPI Number	:	1992466429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL COLLERAN MT-BC

Provider Business Mailing Address
First Line	:	3151 STONY ST
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1913
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3151 STONY ST
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1913
Country	:	US
Telephone Number	:	914-885-1995
Fax Number	:

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

Provider Enumeration Date	:	01/06/2022
Last Update Date	:	01/06/2022

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