Provider Demographics
NPI:1770836264
Name:ROSARIO COLLAZO, LUISA I (MSWC)
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:I
Last Name:ROSARIO COLLAZO
Suffix:
Gender:F
Credentials:MSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 15206
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-9858
Mailing Address - Country:US
Mailing Address - Phone:787-553-6060
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 15206
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-9858
Practice Address - Country:US
Practice Address - Phone:787-553-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-21
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR107161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical