Roosevelt Collins Jr., B.A.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

141 East Main St.
Waterbury, CT 06702-1701

Phone

(203) 574-9000

Fax

(203) 574-9006

NPI assigned

Mar 21, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378166400000",
    "number": "1942575162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 E MAIN ST",
            "address_2": "UITE 402",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067022310",
            "telephone_number": "203-574-9000",
            "fax_number": "203-574-9006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 EAST MAIN ST.",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067021701",
            "telephone_number": "203-574-9000",
            "fax_number": "203-574-9006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLINS",
        "first_name": "ROOSEVELT",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "B.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-03-21",
        "last_updated": "2013-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Perry Coles
• Sara Whipple Coles, PA-C
• Ryann Kathleen Collette
• Kaylin Collier
• Meghann A Collins, LPC
• Samantha Collins
• Gregory Myrus Colodner, MD
• Dawn Marie Colomb-Lippa, PHYSICIAN ASSISTANT
• Dayalee Colon
• William Colson, LADC

• Mental Health Counselor in Waterbury, CT
• Providers in Waterbury, CT by specialty
• Mental Health Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.