Provider Demographics
NPI:1043603103
Name:COLLAZO CEDENO, TISELA M (LCSW)
Entity Type:Individual
Prefix:
First Name:TISELA
Middle Name:M
Last Name:COLLAZO CEDENO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TISELA
Other - Middle Name:M
Other - Last Name:MARRERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2575 EAGLE BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-6093
Mailing Address - Country:US
Mailing Address - Phone:407-552-1019
Mailing Address - Fax:
Practice Address - Street 1:13350 W COLONIAL DR STE 340
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3977
Practice Address - Country:US
Practice Address - Phone:407-654-4433
Practice Address - Fax:407-926-0209
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-13
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW138441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical