Provider Demographics
NPI:1770462160
Name:COLLAZO HERNANDEZ, JOSE LUIS (LCSW)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:COLLAZO HERNANDEZ
Suffix:
Gender:M
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:Q13 CALLE JUAN P VARGAS
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-6786
Mailing Address - Country:US
Mailing Address - Phone:939-865-9631
Mailing Address - Fax:
Practice Address - Street 1:Q13 CALLE JUAN P VARGAS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-6786
Practice Address - Country:US
Practice Address - Phone:939-865-9631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15660104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker