Basic Information
| Provider Information | |||||||||
| NPI: | 1720336977 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLLIER | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | FABER | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PMH-NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 CHURCH ST | ||||||||
| Address2: | SUITE 90-104 | ||||||||
| City: | PEMBROKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023591929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817546545 | ||||||||
| FaxNumber: | 7815360016 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 CHURCH ST | ||||||||
| Address2: | SUITE 90-104 | ||||||||
| City: | PEMBROKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023591929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817546545 | ||||||||
| FaxNumber: | 7815360016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2012 | ||||||||
| LastUpdateDate: | 06/27/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | RN282781 | MA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
ID Information
| ID | Type | State | Issuer | Description | 110095345A | 05 | MA | MEDICAID |