Provider Demographics
NPI:1376612234
Name:COLLINS, DIANA J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:J
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SOUTH RIVER ROAD
Mailing Address - Street 2:UNIT 63
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110
Mailing Address - Country:US
Mailing Address - Phone:603-626-1446
Mailing Address - Fax:603-626-1446
Practice Address - Street 1:40 SOUTH RIVER ROAD
Practice Address - Street 2:UNIT 63
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110
Practice Address - Country:US
Practice Address - Phone:603-626-1446
Practice Address - Fax:603-626-1446
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH394103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE1793Medicare ID - Type Unspecified