Provider Demographics
NPI:1588386445
Name:COLLINS, KATHY FIELDING (LPE)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:FIELDING
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SANTIAGO WAY
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND CENTER
Mailing Address - State:ME
Mailing Address - Zip Code:04021-3454
Mailing Address - Country:US
Mailing Address - Phone:207-232-5748
Mailing Address - Fax:
Practice Address - Street 1:117 STROUDWATER ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4045
Practice Address - Country:US
Practice Address - Phone:207-854-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPE926103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool