Provider Demographics
NPI:1649695255
Name:COLLINS, CHRISTINE HARRISON (LMSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:HARRISON
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:HARRISON
Other - Last Name:TERRANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:991 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-1608
Mailing Address - Country:US
Mailing Address - Phone:631-588-8900
Mailing Address - Fax:631-588-8901
Practice Address - Street 1:991 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1608
Practice Address - Country:US
Practice Address - Phone:631-588-8900
Practice Address - Fax:631-588-8901
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091137104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker