MEDICARE: MRS. NELL CP COLLINS LCSW

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	SW7250	FL

General Provider Information

NPI Number	:	1891974572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NELL CP COLLINS LCSW

Provider Business Mailing Address
First Line	:	4440 PGA BLVD
Second Line	:	SUITE 306
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-6539
Country	:	US
Telephone Number	:	561-371-2200
Fax Number	:	561-630-8410

Provider Business Practice Location Address
First Line	:	4440 PGA BLVD
Second Line	:	SUITE 306
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-6539
Country	:	US
Telephone Number	:	561-371-2200
Fax Number	:	561-630-8410

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

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	10/30/2007

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