Provider Demographics
NPI:1013016583
Name:COLLINS, MARY E (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 242
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-0242
Mailing Address - Country:US
Mailing Address - Phone:315-554-8117
Mailing Address - Fax:315-554-8118
Practice Address - Street 1:29 FENNELL ST
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-1117
Practice Address - Country:US
Practice Address - Phone:315-673-9845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730709531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical