Provider Demographics
NPI:1770832032
Name:COLLINS, ISAAC WILSON (LMSW)
Entity Type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:WILSON
Last Name:COLLINS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-4020
Mailing Address - Country:US
Mailing Address - Phone:585-414-6264
Mailing Address - Fax:
Practice Address - Street 1:131 W BROAD ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14614-1103
Practice Address - Country:US
Practice Address - Phone:585-262-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0868161041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY086816OtherNEW YORK STATE EDUCATION DEPARTMENT