Provider Demographics
NPI:1972853547
Name:COLONIAL YOUTH & FAMILY SERVICES
Entity type:Organization
Organization Name:COLONIAL YOUTH & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORK
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RLCSW
Authorized Official - Phone:631-921-3505
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951
Mailing Address - Country:US
Mailing Address - Phone:631-281-4461
Mailing Address - Fax:631-281-4258
Practice Address - Street 1:1235 MONTAUK HIGHWAY
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950
Practice Address - Country:US
Practice Address - Phone:631-284-4461
Practice Address - Fax:631-281-4258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health