Provider Demographics
NPI:1861550923
Name:COLLABOLLETTA, ERNEST A (PSYD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:A
Last Name:COLLABOLLETTA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 RIDGEWAY
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-3913
Mailing Address - Country:US
Mailing Address - Phone:914-761-3411
Mailing Address - Fax:914-761-3411
Practice Address - Street 1:99 RIDGEWAY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-3913
Practice Address - Country:US
Practice Address - Phone:914-761-3411
Practice Address - Fax:914-761-3411
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011745103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist