Provider Demographics
NPI:1730240516
Name:DOWNES, COLLEEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:
Last Name:DOWNES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 VAN PELT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2409
Mailing Address - Country:US
Mailing Address - Phone:718-720-2576
Mailing Address - Fax:
Practice Address - Street 1:950 CASTLETON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1813
Practice Address - Country:US
Practice Address - Phone:718-720-2576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR039784-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02239389Medicaid
NY7479741OtherGHI
NYP2543377OtherOXFORD
NYN1B402Medicare ID - Type UnspecifiedMEDICARE