Provider Demographics
NPI:1467621466
Name:COLLINS, JUDITH R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:R
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 1:455 POINCIANNA DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2135
Mailing Address - Country:US
Mailing Address - Phone:704-564-4601
Mailing Address - Fax:
Practice Address - Street 1:455 POINCIANNA DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2135
Practice Address - Country:US
Practice Address - Phone:704-564-4601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7634103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist