Provider Demographics
NPI:1801260070
Name:COLLAZO GONZALEZ, GLORIVIE (LIC)
Entity type:Individual
Prefix:MRS
First Name:GLORIVIE
Middle Name:
Last Name:COLLAZO GONZALEZ
Suffix:
Gender:F
Credentials:LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 52414
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-9205
Mailing Address - Country:US
Mailing Address - Phone:787-365-7070
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA RAFAEL CORDERO
Practice Address - Street 2:ESQUINA TROCHE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-745-0340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-25
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical