MEDICARE: DR. MARY H COLLINS PSY.D.

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	103TC0700X	Clinical Psychologist	36100	TX
2	103TC0700X	Clinical Psychologist	071008504	IL

General Provider Information

NPI Number	:	1881971612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY H COLLINS PSY.D.

Provider Business Mailing Address
First Line	:	1510 LONGVALLEY RD
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-5125
Country	:	US
Telephone Number	:	847-513-2532
Fax Number	:

Provider Business Practice Location Address
First Line	:	1430 N ARLINGTON HEIGHTS RD STE 114
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-4823
Country	:	US
Telephone Number	:	210-201-2933
Fax Number	:

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

Provider Enumeration Date	:	11/08/2011
Last Update Date	:	05/18/2021

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