Provider Demographics
NPI:1124516448
Name:KOLIDAS, EVELYN ATHENA (PHD)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:ATHENA
Last Name:KOLIDAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 80TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2617
Mailing Address - Country:US
Mailing Address - Phone:646-483-7050
Mailing Address - Fax:
Practice Address - Street 1:947 80TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2617
Practice Address - Country:US
Practice Address - Phone:646-483-7050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022607103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth