Individual
COLLEEN CASELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1227 MONTAUK HWY UNIT 2, OAKDALE, NY 11769-1492
(631) 218-1545
Mailing address
74 CHARLA DR, SOUTHAMPTON, NY 11968-3602
(631) 702-3562
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2962110
SEIT
NY
Enumeration date
11/22/2020
Last updated
11/22/2020
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