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General NPI Number Information
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NPI Number | 1285664128
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Entity Type | Individual
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Provider Name | MICHELLE COLLINS PHD
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Gender | Female
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 35 LAUREL RD
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City | HAMDEN
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State | CT
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Zip | 06517-4019
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Country | US
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Telephone | 203-641-1339
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Fax | 888-515-1420
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Provider Business Mailing Address
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Address Line | 17 S MARYLAND AVE STE C
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-2912
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Country | US
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Telephone | 516-767-2166
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Fax | 888-515-1420
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 002875
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License Number State | CT
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