Provider Demographics
NPI:1245698414
Name:COLL, JANTRA MARGARITA (PSYD)
Entity type:Individual
Prefix:DR
First Name:JANTRA
Middle Name:MARGARITA
Last Name:COLL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 GRAHAM AVE
Mailing Address - Street 2:APT. 1R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4934
Mailing Address - Country:US
Mailing Address - Phone:917-270-7178
Mailing Address - Fax:
Practice Address - Street 1:505 GRAHAM AVE
Practice Address - Street 2:APT. 1R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-4934
Practice Address - Country:US
Practice Address - Phone:917-270-7178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021533103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical