Provider Demographics
NPI:1518264639
Name:COLLINS, SALLY JANE (LMFT, MA, ATR)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:JANE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LMFT, MA, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CHRISTOPHER STREET,
Mailing Address - Street 2:APT. 3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014
Mailing Address - Country:US
Mailing Address - Phone:917-861-7496
Mailing Address - Fax:
Practice Address - Street 1:190 N 10TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-9325
Practice Address - Country:US
Practice Address - Phone:917-861-7496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000853106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000853OtherMARRIAGE AND FAMILY THERAPY LICENSE ID NUMBER