Basic Information
| Provider Information | |||||||||
| NPI: | 1750328779 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | FRANCIS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 ELTON RD N | ||||||||
| Address2: | |||||||||
| City: | STEWART MANOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115302203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167756645 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17900 LINDEN BLVD | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114250001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185261000 | ||||||||
| FaxNumber: | 7182988515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | R046254-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.