Provider Demographics
NPI:1588863922
Name:COLLADO, JERRY (CASAC)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:COLLADO
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:MR
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:COLLADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASAC
Mailing Address - Street 1:3512 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1808
Mailing Address - Country:US
Mailing Address - Phone:585-729-7883
Mailing Address - Fax:
Practice Address - Street 1:46 PRINCE ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1023
Practice Address - Country:US
Practice Address - Phone:585-729-7883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)