Provider Demographics
NPI:1629362942
Name:COLLINS, THOMAS PETER
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PETER
Last Name:COLLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 GREENWOOD MTN RD
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:ME
Mailing Address - Zip Code:04238-3553
Mailing Address - Country:US
Mailing Address - Phone:207-966-2382
Mailing Address - Fax:207-966-2382
Practice Address - Street 1:436 GREENWOOD MTN RD
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:ME
Practice Address - Zip Code:04238-3553
Practice Address - Country:US
Practice Address - Phone:207-966-2382
Practice Address - Fax:207-966-2382
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME664103TA0400X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent