Provider Demographics
NPI:1528133345
Name:COLLINS, KATHLEEN GAIL (LCSW-R ,CASAC)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:GAIL
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LCSW-R ,CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 RISELEY RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT TREMPER
Mailing Address - State:NY
Mailing Address - Zip Code:12457-5310
Mailing Address - Country:US
Mailing Address - Phone:845-688-7423
Mailing Address - Fax:
Practice Address - Street 1:239 GOLDEN HILL LN
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6441
Practice Address - Country:US
Practice Address - Phone:845-340-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR037810-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N1A691Medicare PIN