Provider Demographics
NPI:1154518249
Name:COLOSA, ELIZABETH MARIE
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:COLOSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 WHITE PLAINS RD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-5537
Mailing Address - Country:US
Mailing Address - Phone:914-573-7893
Mailing Address - Fax:
Practice Address - Street 1:475 WHITE PLAINS RD
Practice Address - Street 2:SUITE 18
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-5537
Practice Address - Country:US
Practice Address - Phone:914-573-7893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001226106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist