Provider Demographics
NPI:1295334464
Name:COLLAZO CARDONA, KARLA M (LCSW)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:M
Last Name:COLLAZO CARDONA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 CALLE BOGOTA
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-8503
Mailing Address - Country:US
Mailing Address - Phone:787-502-6101
Mailing Address - Fax:
Practice Address - Street 1:CARR #1 KM 48.8
Practice Address - Street 2:BO BEATRIZ
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-502-6101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR153891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical