Provider Demographics
NPI:1356302020
Name:BREENE, COLLEN Q (PHD)
Entity Type:Individual
Prefix:
First Name:COLLEN
Middle Name:Q
Last Name:BREENE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 PAUL REVERE RD
Mailing Address - Street 2:
Mailing Address - City:OIL CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16301-1136
Mailing Address - Country:US
Mailing Address - Phone:814-676-2693
Mailing Address - Fax:
Practice Address - Street 1:62 PAUL REVERE RD
Practice Address - Street 2:
Practice Address - City:OIL CITY
Practice Address - State:PA
Practice Address - Zip Code:16301-1136
Practice Address - Country:US
Practice Address - Phone:814-676-2693
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005957L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015383500003Medicaid