Individual
MISS COLLEEN GRACE GILLIGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2171 JERICHO TPKE STE LL3, COMMACK, NY 11725-2900
(631) 603-5002
Mailing address
1841 BRENTWOOD RD, BRENTWOOD, NY 11717-4625
(631) 853-7300
(631) 853-7301
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
823156527
PSCHOTHERAPY/DIRECT CARE
NY
Enumeration date
09/15/2011
Last updated
03/02/2020
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