Healthcare Provider Details

I. General information

NPI: 1154538056
Provider Name (Legal Business Name): MICHELLE LYNNE BUTMAN COLLINS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE BUTMAN LICSW

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44B GROVE ST UNIT 8
MELROSE MA
02176-4696
US

IV. Provider business mailing address

24 KENDRICK RD
WAKEFIELD MA
01880-4308
US

V. Phone/Fax

Practice location:
  • Phone: 781-226-1606
  • Fax:
Mailing address:
  • Phone: 857-540-1021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115426
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: