Provider Demographics
NPI:1154538056
Name:COLLINS, MICHELLE LYNNE BUTMAN (LICSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNNE BUTMAN
Last Name:COLLINS
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:BUTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:24 KENDRICK RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-4308
Mailing Address - Country:US
Mailing Address - Phone:857-540-1021
Mailing Address - Fax:
Practice Address - Street 1:333 NORTH AVE STE A
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-2300
Practice Address - Country:US
Practice Address - Phone:781-226-1606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MA1154261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical