MEDICARE: DR. JENNIFER COLLINS PH.D, NCSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1225852783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER COLLINS PH.D, NCSP

Provider Business Mailing Address
First Line	:	4849 PIMLICO RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-6040
Country	:	US
Telephone Number	:	410-291-2390
Fax Number	:

Provider Business Practice Location Address
First Line	:	4849 PIMLICO RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-6040
Country	:	US
Telephone Number	:	410-291-2390
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2024
Last Update Date	:	11/12/2024

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