Basic Information
| Provider Information | |||||||||
| NPI: | 1588006506 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SWART | ||||||||
| OtherFirstName: | SARAH | ||||||||
| OtherMiddleName: | JEAN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 491 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ATHOL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013311846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782499490 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 417 LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011043736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137470705 | ||||||||
| FaxNumber: | 4137327075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2013 | ||||||||
| LastUpdateDate: | 01/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.