Provider Demographics
NPI:1104353820
Name:COLAVITO, CHRISTINE (LMHC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:COLAVITO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WATSON LN
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2824
Mailing Address - Country:US
Mailing Address - Phone:631-403-0782
Mailing Address - Fax:
Practice Address - Street 1:764 ROUTE 25A STE 7
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1231
Practice Address - Country:US
Practice Address - Phone:631-403-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004448101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health