Provider Demographics
NPI:1720589021
Name:COLON COLLAZO, JOANNA LIZ (MA, PSIC)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:LIZ
Last Name:COLON COLLAZO
Suffix:
Gender:F
Credentials:MA, PSIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 BOSQUE DE LAS PALMAS
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-589-8043
Mailing Address - Fax:
Practice Address - Street 1:197 BOSQUE DE LAS PALMAS
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9250
Practice Address - Country:US
Practice Address - Phone:787-589-8043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5913103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty