Provider Demographics
NPI:1235851387
Name:COLLINS PETERKIN, MERRILL HEATH (MT-BC)
Entity Type:Individual
Prefix:
First Name:MERRILL
Middle Name:HEATH
Last Name:COLLINS PETERKIN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:MERRILL
Other - Middle Name:HEATH
Other - Last Name:COLLINS PETERKIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MT-BC
Mailing Address - Street 1:96 HECKER AVE
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-5310
Mailing Address - Country:US
Mailing Address - Phone:203-722-0406
Mailing Address - Fax:
Practice Address - Street 1:96 HECKER AVE
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-5310
Practice Address - Country:US
Practice Address - Phone:203-722-0406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13063225A00000X
13063225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist