Provider Demographics
NPI:1215526108
Name:COLOMBO, LAUREL L
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:L
Last Name:COLOMBO
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 1:34 UPPER HIBERNIA RD
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-4531
Mailing Address - Country:US
Mailing Address - Phone:201-953-1614
Mailing Address - Fax:
Practice Address - Street 1:34 UPPER HIBERNIA RD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-4531
Practice Address - Country:US
Practice Address - Phone:201-953-1614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00606800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional