Healthcare Provider Details

I. General information

NPI: 1851205082
Provider Name (Legal Business Name): COLLEEN AMELIA KING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 REGENCY PARK DR APT 230
AGAWAM MA
01001-2264
US

IV. Provider business mailing address

230 REGENCY PARK DR APT 230
AGAWAM MA
01001-2264
US

V. Phone/Fax

Practice location:
  • Phone: 413-519-6526
  • Fax:
Mailing address:
  • Phone: 413-519-6526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: