Provider Demographics
NPI:1962509026
Name:COLLINS, LISA A (LMSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:305 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-2524
Mailing Address - Country:US
Mailing Address - Phone:607-729-1295
Mailing Address - Fax:607-777-9497
Practice Address - Street 1:305 MAIN ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-2524
Practice Address - Country:US
Practice Address - Phone:607-729-1295
Practice Address - Fax:607-777-9497
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0737781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical