Provider Demographics
NPI:1801029236
Name:ISDITH-COLLADO, TANYA (LMSW)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:ISDITH-COLLADO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SUYDAM ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-2509
Mailing Address - Country:US
Mailing Address - Phone:917-939-8426
Mailing Address - Fax:
Practice Address - Street 1:10324 CORONA AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3177
Practice Address - Country:US
Practice Address - Phone:929-522-0952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0873731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical