Healthcare Provider Details

I. General information

NPI: 1982533394
Provider Name (Legal Business Name): MATTHEW COLLINS MSW LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3284 IVANHOE AVE
SAINT LOUIS MO
63139-2200
US

IV. Provider business mailing address

3284 IVANHOE AVE
SAINT LOUIS MO
63139-2200
US

V. Phone/Fax

Practice location:
  • Phone: 314-435-3408
  • Fax:
Mailing address:
  • Phone: 314-435-3408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801114925
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2002002749
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: