Healthcare Provider Details

I. General information

NPI: 1255148581
Provider Name (Legal Business Name): AMANDA CLAIRE COLLINS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOWDOIN SQ FL 6
BOSTON MA
02114-2927
US

IV. Provider business mailing address

308 WATER ST
WAKEFIELD MA
01880-2536
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-8895
  • Fax:
Mailing address:
  • Phone: 469-321-0607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: