Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 664 | ME |
Y | 103G00000X | Clinical Psychologist | 664 | ME |
Y | 103TC0700X | Clinical Psychologist | 664 | ME |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 664 | ME |
NPI | 1629362942 |
---|---|
Provider Name | Dr. Thomas Peter Collins |
First Address | Hebron, ME 04238-3553 |
Second Address | Hebron, ME 04238-3553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2011 |
Last Update Date | 03/06/2011 |