Provider Demographics
NPI:1548310113
Name:COLWELL, CAROLYN (LCSW)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:COLWELL
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 1:256 MAIN ST
Mailing Address - Street 2:SUITE 1102
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1733
Mailing Address - Country:US
Mailing Address - Phone:631-754-6822
Mailing Address - Fax:631-754-6634
Practice Address - Street 1:256 MAIN ST
Practice Address - Street 2:SUITE 1102
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1733
Practice Address - Country:US
Practice Address - Phone:631-754-6822
Practice Address - Fax:631-754-6634
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-049907-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3800205OtherGHI
NYP888865OtherOXFORD
NY198707OtherMHN
NY077059OtherVALUE OPTIONS