Provider Demographics
NPI:1669536512
Name:COLLINS, KIRSTEN (MA)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAHEY PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - Street 2:41 MALL ROAD
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805
Mailing Address - Country:US
Mailing Address - Phone:781-744-8085
Mailing Address - Fax:781-744-5433
Practice Address - Street 1:LAHEY HEALTH PRIMARY CARE, BILLERICA
Practice Address - Street 2:790 BOSTON ROAD, SUITE 301
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821
Practice Address - Country:US
Practice Address - Phone:978-670-8500
Practice Address - Fax:978-670-8548
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1312294Medicare ID - Type Unspecified