Provider Demographics
NPI:1710733191
Name:COLBERT, SIMONE RENEE' (CD(DONA), CLC)
Entity type:Individual
Prefix:MS
First Name:SIMONE
Middle Name:RENEE'
Last Name:COLBERT
Suffix:
Gender:F
Credentials:CD(DONA), CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9516 AVENUE A APT 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-1385
Mailing Address - Country:US
Mailing Address - Phone:917-795-5397
Mailing Address - Fax:
Practice Address - Street 1:9516 AVENUE A APT 4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-1385
Practice Address - Country:US
Practice Address - Phone:917-795-5397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324290174N00000X
NY14950374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN