Provider Demographics
NPI:1871931170
Name:COLONIAL YOUTH AND FAMILY SERVICES
Entity type:Organization
Organization Name:COLONIAL YOUTH AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-281-4461
Mailing Address - Street 1:1235 MONTAUK HWY
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-2934
Mailing Address - Country:US
Mailing Address - Phone:631-281-4461
Mailing Address - Fax:631-281-4258
Practice Address - Street 1:1235 MONTAUK HWY
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-2934
Practice Address - Country:US
Practice Address - Phone:631-281-4461
Practice Address - Fax:631-281-4258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health