Provider Demographics
NPI:1154885432
Name:CACACE, COLLEEN ELAINE (MSED)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ELAINE
Last Name:CACACE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 TAGGERT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-2917
Mailing Address - Country:US
Mailing Address - Phone:850-292-6568
Mailing Address - Fax:
Practice Address - Street 1:2424 E YORK ST STE 114
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-3034
Practice Address - Country:US
Practice Address - Phone:267-225-2298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor