Provider Demographics
NPI:1013220227
Name:RIVERA COLLAZO, JULIETTE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JULIETTE
Middle Name:
Last Name:RIVERA COLLAZO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JULIETTE
Other - Middle Name:
Other - Last Name:RIVERA COLLAZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYCHOLOGIST
Mailing Address - Street 1:PO BOX 3593
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3593
Mailing Address - Country:US
Mailing Address - Phone:787-601-7485
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 7004
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00732-7004
Practice Address - Country:US
Practice Address - Phone:787-601-7485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3808103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical