Provider Demographics
NPI:1194086959
Name:COLLAZO, KATHRYN E (BA)
Entity type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:E
Last Name:COLLAZO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2540 BENSON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4407
Mailing Address - Country:US
Mailing Address - Phone:718-382-1060
Mailing Address - Fax:718-382-1449
Practice Address - Street 1:292 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6307
Practice Address - Country:US
Practice Address - Phone:212-418-0343
Practice Address - Fax:212-980-0073
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator