Provider Demographics
NPI:1548372592
Name:COLLINS EL, MILTON (LCSW)
Entity type:Individual
Prefix:
First Name:MILTON
Middle Name:
Last Name:COLLINS EL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 WILLSHIRE BLVD
Mailing Address - Street 2:STE 241
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707
Mailing Address - Country:US
Mailing Address - Phone:407-830-4755
Mailing Address - Fax:407-837-7772
Practice Address - Street 1:274 WILLSHIRE BLVD
Practice Address - Street 2:STE 241
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707
Practice Address - Country:US
Practice Address - Phone:407-830-4755
Practice Address - Fax:407-837-7772
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00038451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z6690Medicare ID - Type Unspecified