Healthcare Provider Details

I. General information

NPI: 1972421907
Provider Name (Legal Business Name): MARY ELIZABETH COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S EDWIN C MOSES BLVD
DAYTON OH
45417-3424
US

IV. Provider business mailing address

PO BOX 932944
CLEVELAND OH
44193-0027
US

V. Phone/Fax

Practice location:
  • Phone: 937-734-8333
  • Fax:
Mailing address:
  • Phone: 937-734-4310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: