Provider Demographics
NPI:1285449363
Name:COLLINGSWORTH, EMILY-ANN TERESA (RADT)
Entity type:Individual
Prefix:
First Name:EMILY-ANN
Middle Name:TERESA
Last Name:COLLINGSWORTH
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 FAIRHAVEN AVE APT 321
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8747
Mailing Address - Country:US
Mailing Address - Phone:714-757-2296
Mailing Address - Fax:
Practice Address - Street 1:1300 FAIRHAVEN AVE APT 321
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8747
Practice Address - Country:US
Practice Address - Phone:714-757-2296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1598690225106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty