Provider Demographics
NPI:1821707514
Name:COLLAZO, CRISTINA (CASAC)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:
Last Name:COLLAZO
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:MRS
Other - First Name:CRISTINA
Other - Middle Name:
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CASAC
Mailing Address - Street 1:1408 WEBSTER AVE APT 20E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-1872
Mailing Address - Country:US
Mailing Address - Phone:914-290-8964
Mailing Address - Fax:
Practice Address - Street 1:20 CHURCH ST STE 2
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-1926
Practice Address - Country:US
Practice Address - Phone:914-683-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35907101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)