Provider Demographics
NPI:1518013861
Name:KOLESAR, NINA ALEXANDRA (PSYD)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:ALEXANDRA
Last Name:KOLESAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 WILLOW ST STE 5
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-2806
Mailing Address - Country:US
Mailing Address - Phone:607-398-4549
Mailing Address - Fax:607-442-0910
Practice Address - Street 1:1133 WILLOW ST STE 5
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-2806
Practice Address - Country:US
Practice Address - Phone:607-398-4549
Practice Address - Fax:607-442-0910
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2018-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020743103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical