Provider Demographics
NPI:1598833238
Name:COLLINS, FELICIA LANGFORD (LICSW)
Entity Type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:LANGFORD
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-1142
Mailing Address - Country:US
Mailing Address - Phone:781-862-7319
Mailing Address - Fax:
Practice Address - Street 1:169 ELM STREET
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5356
Practice Address - Country:US
Practice Address - Phone:781-894-8440
Practice Address - Fax:781-894-1202
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10194211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA703136OtherTUFTS
MAM18633OtherBCBS
MA1303287OtherMBHP
MA1303287Medicaid
MANP01332OtherBOSTON MED
MA1004745OtherNHP
MA99618201OtherNETWORK HEALTH
MAP10329OtherBCBS
MAM18633OtherBCBS
MA1004745OtherNHP