Provider Demographics
NPI:1073682647
Name:COLLINS, KELLY S (LCSW)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:S
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2020
Mailing Address - Country:US
Mailing Address - Phone:732-235-6800
Mailing Address - Fax:
Practice Address - Street 1:130 E 101ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6106
Practice Address - Country:US
Practice Address - Phone:212-534-8596
Practice Address - Fax:212-860-8407
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071606R1041C0700X
NJ44SC054357001041C0700X
NY0716061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical