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General NPI Number Information
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NPI Number | 1922801133
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Entity Type | Individual
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Provider Name | JORDAN COLLINS
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Gender | Male
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 66 CEDAR ST
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City | NEWINGTON
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State | CT
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Zip | 06111-2633
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Country | US
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Telephone | 877-222-0399
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Fax |
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Provider Business Mailing Address
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Address Line | 42 OLD FARM RD
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City | MERIDEN
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State | CT
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Zip | 06450-7807
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Country | US
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Telephone | 203-859-8879
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 2089
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License Number State | CT
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