Provider Demographics
NPI:1114466174
Name:COLL, ISABEL (BS)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:COLL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:YSABELA
Other - Middle Name:
Other - Last Name:COLL DE PENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:28 RIDGECREST TER
Mailing Address - Street 2:APT 20
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-5240
Mailing Address - Country:US
Mailing Address - Phone:585-857-1341
Mailing Address - Fax:
Practice Address - Street 1:28 RIDGECREST TER
Practice Address - Street 2:APT 20
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-5240
Practice Address - Country:US
Practice Address - Phone:585-857-1341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health