Provider Demographics
NPI:1386664043
Name:COLLINS, PATRICIA MARIE (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MARIE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 AMARK RD
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2149
Mailing Address - Country:US
Mailing Address - Phone:774-826-2012
Mailing Address - Fax:774-826-3157
Practice Address - Street 1:940 BELMONT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5596
Practice Address - Country:US
Practice Address - Phone:774-826-4000
Practice Address - Fax:774-826-3157
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1943133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA435327OtherDIETETIC REGISTRATION
MA1943OtherSTATE LICENSE FOR RD