| Doctor Name: | MARTIN IRVING COLAVITO |
| NPI Number: | 1487801650 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CASAC |
| License Number: | 7929 |
| Business Practice Address: | 17-19 Sussex Street Port Jervis, NY - 127712430 |
| Business Phone Number: | 8458566344 |
| Business Fax Number: | 8458564091 |
| Mailing Address: | 17-19 Sussex Street, PORT JERVIS |
| State: | NY |
| Postal Code: | 127712430 |
| Phone Number: | 8458566344 |
| Fax Number: | 8458564091 |
| NPI Enumeration Date: | 08/19/2008 |
| NPI Last Update Date: | 08/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 7929 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |