Healthcare Provider Details

I. General information

NPI: 1588386247
Provider Name (Legal Business Name): MARIELLE HEATHER COLLINS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVENUE
CLEVELAND OH
44193-0001
US

IV. Provider business mailing address

2617 HAMPSHIRE RD
CLEVELAND HEIGHTS OH
44106-2510
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-9046
  • Fax:
Mailing address:
  • Phone: 304-376-1622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberP.08372
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: