Provider Demographics
NPI:1386830016
Name:COLLINS, DANIELLE TAWANDA (MSW, LSW)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:TAWANDA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:TAWANDA
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:700 MASSACHUSETTS AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3345
Mailing Address - Country:US
Mailing Address - Phone:267-506-1226
Mailing Address - Fax:617-649-8520
Practice Address - Street 1:119 S BURROWES ST STE 604
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-3864
Practice Address - Country:US
Practice Address - Phone:888-500-2067
Practice Address - Fax:617-649-8520
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PASW1414441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program