Provider Demographics
NPI:1154759439
Name:COLONNA, CAREN MICHELLE
Entity type:Individual
Prefix:
First Name:CAREN
Middle Name:MICHELLE
Last Name:COLONNA
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 1:1600 GRAND AVE
Mailing Address - Street 2:APT V1
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1885
Mailing Address - Country:US
Mailing Address - Phone:516-377-5670
Mailing Address - Fax:
Practice Address - Street 1:1600 GRAND AVE
Practice Address - Street 2:APT V1
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-1885
Practice Address - Country:US
Practice Address - Phone:516-377-5670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency