Provider Demographics
NPI:1700148814
Name:COLLINS, TALEEA LESLIE (MA)
Entity Type:Individual
Prefix:MS
First Name:TALEEA
Middle Name:LESLIE
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 1:55 W 116TH ST
Mailing Address - Street 2:SUITE 132
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2508
Mailing Address - Country:US
Mailing Address - Phone:917-481-2887
Mailing Address - Fax:
Practice Address - Street 1:55 W 116TH ST
Practice Address - Street 2:SUITE 132
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-2508
Practice Address - Country:US
Practice Address - Phone:917-481-2887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116785021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist