Provider Demographics
NPI:1639601495
Name:COLLAZO-RODRIGUEZ, SAMIRIS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SAMIRIS
Middle Name:
Last Name:COLLAZO-RODRIGUEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 CALLE DAGUAO
Mailing Address - Street 2:URB VILLAS DE BUENAVENTURA
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767
Mailing Address - Country:US
Mailing Address - Phone:787-951-3858
Mailing Address - Fax:
Practice Address - Street 1:51 CALLE ESCUTE
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3417
Practice Address - Country:US
Practice Address - Phone:787-561-3585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5652103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling