Provider Demographics
NPI:1407407117
Name:COLLINS, KATERI BOBBIE
Entity Type:Individual
Prefix:MISS
First Name:KATERI
Middle Name:BOBBIE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 PLAIN ST UNIT 74J
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-7162
Mailing Address - Country:US
Mailing Address - Phone:508-690-6069
Mailing Address - Fax:857-219-5242
Practice Address - Street 1:74 PLAIN ST UNIT 74J
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-7162
Practice Address - Country:US
Practice Address - Phone:508-690-6069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health