Provider Demographics
NPI:1386342780
Name:COLLAZO, MARIA DEL CARMEN SR (MSW)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DEL CARMEN
Last Name:COLLAZO
Suffix:SR
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB VILLA MADRID CALLE 11
Mailing Address - Street 2:RR19
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769
Mailing Address - Country:US
Mailing Address - Phone:787-232-5784
Mailing Address - Fax:
Practice Address - Street 1:URB. VILLA MADRID CALLE 11 RR19
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:787-232-5784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR138971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4879631Medicaid