Provider Demographics
NPI:1285664128
Name:COLLINS, MICHELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:COLLINS-GREENE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17 S MARYLAND AVE STE C
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2912
Mailing Address - Country:US
Mailing Address - Phone:516-767-2166
Mailing Address - Fax:888-515-1420
Practice Address - Street 1:35 LAUREL RD
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-4019
Practice Address - Country:US
Practice Address - Phone:203-641-1339
Practice Address - Fax:888-515-1420
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002875103TC0700X
NY010707103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP844738OtherOXFORD
NY6800686OtherGHI
NY01792983Medicaid
CTCBHP5838MCMedicaid