Provider Demographics
NPI:1053435107
Name:GARVEY, COLLEEN MICHELLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:MICHELLE
Last Name:GARVEY
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 1:2775 ISLAND CHANNEL RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-3324
Mailing Address - Country:US
Mailing Address - Phone:516-889-0080
Mailing Address - Fax:516-785-4289
Practice Address - Street 1:26 E PARK AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3595
Practice Address - Country:US
Practice Address - Phone:516-889-0080
Practice Address - Fax:516-785-4289
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO48618-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNG6741Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER