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NPI Code Detail

MEDICARE: MR. REGINALD DEVONE COLLINS

MEDICARE:  MR. REGINALD DEVONE COLLINS
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
11041C0700XClinical Social WorkerSW23548FL

General Provider Information

NPI Number : 1366262644
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. REGINALD DEVONE COLLINS
Provider Business Mailing Address
First Line : 6055 SW 19TH PL
Second Line :
City : NORTH LAUDERDALE
State : FL
Zip : 33068-4622
Country : US
Telephone Number : 954-618-7479
Fax Number :
Provider Business Practice Location Address
First Line : 6055 SW 19TH PL
Second Line :
City : NORTH LAUDERDALE
State : FL
Zip : 33068-4622
Country : US
Telephone Number : 954-618-7479
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2024
Last Update Date : 10/11/2024

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Directions to “ MR. REGINALD DEVONE COLLINS ” Practice Location

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