Kathleen Koller, MHC-LP

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

P107677 Issued in NY

Practice address

135 Corson Ave
Staten Island, NY 10301-2933

Phone

(917) 385-7929

NPI assigned

Feb 11, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613001600000",
    "number": "1669065504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1563",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101591563",
            "telephone_number": "917-355-7929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 CORSON AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103012933",
            "telephone_number": "917-385-7929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLER",
        "first_name": "KATHLEEN",
        "credential": "MHC-LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-11",
        "last_updated": "2021-02-11",
        "certification_date": "2021-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "P107677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suma Kolenovic, LMSW
• Shannen Kolesar, MS, OTR/L
• Andrey Kolesnikov, MD
• Milena Kolesnikova
• Madhavi Latha Kolla, MD
• Eliza Kollie I
• Karishma Kollipara, D.O
• Raunak Kollipara, MD
• Kolloori & Kolloori, Physicians, LLC
• Benjamin Joe Kolloori, MD

• Mental Health Counselor in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.