MEDICARE: DR. DANA LANG COLLINS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor		CA
2	101YM0800X	Mental Health Counselor
3	103T00000X	Psychologist		CA
4	103TC1900X	Counseling Psychologist
5	390200000X	Student in an Organized Health Care Education/Training Program		CA
6	103TC1900X	Counseling Psychologist	023071	NY

General Provider Information

NPI Number	:	1346783735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANA LANG COLLINS PHD

Provider Business Mailing Address
First Line	:	291 CROWN ST APT B4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-3033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	291 CROWN ST APT B4
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-3033
Country	:	US
Telephone Number	:	510-812-6780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2016
Last Update Date	:	01/27/2021

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