Provider Demographics
NPI:1851861066
Name:COLLAZO, NILSA (PHD)
Entity Type:Individual
Prefix:DR
First Name:NILSA
Middle Name:
Last Name:COLLAZO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 CALLE JUAN H CINTRON
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-0515
Mailing Address - Country:US
Mailing Address - Phone:787-439-9427
Mailing Address - Fax:
Practice Address - Street 1:CARR 135 KM 64.2
Practice Address - Street 2:
Practice Address - City:CASTANER
Practice Address - State:PR
Practice Address - Zip Code:00631
Practice Address - Country:US
Practice Address - Phone:787-829-5010
Practice Address - Fax:787-544-3860
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2104103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical