Provider Demographics
NPI:1134332356
Name:COLAROSSI, PATRICIA MORAN (CSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MORAN
Last Name:COLAROSSI
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MONTANA PL
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2607
Mailing Address - Country:US
Mailing Address - Phone:631-423-1185
Mailing Address - Fax:
Practice Address - Street 1:10 MONTANA PL
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-2607
Practice Address - Country:US
Practice Address - Phone:631-423-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO382541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN3B-761Medicare ID - Type Unspecified