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General NPI Number Information
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NPI Number | 1912412024
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Entity Type | Individual
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Provider Name | SHANNON HAZEL COLLINS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 12/12/2017
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Provider Practice Location Address
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Address Line | 18 EAST 16TH STREET SUITE 503, OFFICE 2
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City | NEW YORK
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State | NY
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Zip | 10003
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Country | US
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Telephone | 646-543-9862
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Fax |
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Provider Business Mailing Address
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Address Line | 3535 82ND ST APT 51
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-5127
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Country | US
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Telephone | 646-894-1388
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Fax |
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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 | 022392
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License Number State | NY
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