Provider Demographics
NPI:1407606791
Name:MILTON COUNSELING COLLABORATIVE
Entity Type:Organization
Organization Name:MILTON COUNSELING COLLABORATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORIN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-293-1657
Mailing Address - Street 1:65 ADAMS ST STE 6
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3413
Mailing Address - Country:US
Mailing Address - Phone:617-293-1657
Mailing Address - Fax:
Practice Address - Street 1:65 ADAMS ST STE 6
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3413
Practice Address - Country:US
Practice Address - Phone:617-293-1657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty