Basic Information
| Provider Information | |||||||||
| NPI: | 1356638589 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLIGAN | ||||||||
| FirstName: | MAUREEN | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2849 E PINE ST # 8 | ||||||||
| Address2: | |||||||||
| City: | DEMING | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880308618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755439136 | ||||||||
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| Practice Location | |||||||||
| Address1: | 21 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109405704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453437675 | ||||||||
| FaxNumber: | 8453432501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2011 | ||||||||
| LastUpdateDate: | 03/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | CCMH0203321 | NM | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | CCMH0203321 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.