MEDICARE: ERIN MARIE COLLINS LISW

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	1041C0700X	Clinical Social Worker	I-06807	NM

General Provider Information

NPI Number	:	1700111895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN MARIE COLLINS LISW

Provider Business Mailing Address
First Line	:	8205 SPAIN RD NE
Second Line	:	SUITE 106
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-3179
Country	:	US
Telephone Number	:	505-384-7352
Fax Number	:

Provider Business Practice Location Address
First Line	:	2424 JUAN TABO BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-1818
Country	:	US
Telephone Number	:	505-503-1811
Fax Number	:

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

Provider Enumeration Date	:	10/07/2009
Last Update Date	:	10/27/2014

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