Provider Demographics
NPI:1578035796
Name:COLLINS, BRIANNA (LSW)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 VICTORY PKWY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1754
Mailing Address - Country:US
Mailing Address - Phone:513-221-4673
Mailing Address - Fax:513-873-3385
Practice Address - Street 1:2621 VICTORY PKWY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1754
Practice Address - Country:US
Practice Address - Phone:513-221-4673
Practice Address - Fax:513-873-3385
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1903960104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator