Provider Demographics
NPI:1295450211
Name:COLLAZO, LINET (RBT)
Entity type:Individual
Prefix:
First Name:LINET
Middle Name:
Last Name:COLLAZO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 SW 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5776
Mailing Address - Country:US
Mailing Address - Phone:786-375-0562
Mailing Address - Fax:
Practice Address - Street 1:3111 SW 35TH AVE
Practice Address - Street 2:
Practice Address - City:WEST PARK
Practice Address - State:FL
Practice Address - Zip Code:33023-5776
Practice Address - Country:US
Practice Address - Phone:786-375-0562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-236018106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-22-236018OtherBACB