Provider Demographics
NPI:1730404740
Name:KOLLAPPALLIL, MARY JOSEPH (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JOSEPH
Last Name:KOLLAPPALLIL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15011 HILLSIDE AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3319
Mailing Address - Country:US
Mailing Address - Phone:718-739-5778
Mailing Address - Fax:718-523-2728
Practice Address - Street 1:15011 HILLSIDE AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3319
Practice Address - Country:US
Practice Address - Phone:718-739-5778
Practice Address - Fax:718-523-2728
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017693103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical