Provider Demographics
NPI:1194806422
Name:COLLINS, PATRICK T (PHD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:T
Last Name:COLLINS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 46 ROUTE 347
Mailing Address - Street 2:BUILDING 8 10
Mailing Address - City:PORT JEFFESON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776
Mailing Address - Country:US
Mailing Address - Phone:631-928-5071
Mailing Address - Fax:631-928-4784
Practice Address - Street 1:5225 46 ROUTE 347
Practice Address - Street 2:BUILDING 8 10
Practice Address - City:PORT JEFFESON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776
Practice Address - Country:US
Practice Address - Phone:631-928-5071
Practice Address - Fax:631-928-4784
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0049481103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
V09701Medicare ID - Type Unspecified