Healthcare Provider Details

I. General information

NPI: 1376819912
Provider Name (Legal Business Name): PETER KEVIN COLLINS LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 AUBURN ST
MANCHESTER NH
03103-4803
US

IV. Provider business mailing address

17 RIVER MEADOW DR
WEST NEWBURY MA
01985-1400
US

V. Phone/Fax

Practice location:
  • Phone: 603-623-8863
  • Fax:
Mailing address:
  • Phone: 978-837-8680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1479
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: