Provider Demographics
NPI:1992970693
Name:LAGRECA, COLLEEN MARGARET (LCSW)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARGARET
Last Name:LAGRECA
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 1:50 CHARLES LINDBERGH BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3626
Mailing Address - Country:US
Mailing Address - Phone:516-229-2620
Mailing Address - Fax:
Practice Address - Street 1:50 CHARLES LINDBERGH BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3626
Practice Address - Country:US
Practice Address - Phone:516-229-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03762811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical