Miriam Damaris Collazo

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LMHC10000359 Issued in MA

Practice address

405 Grove St Ste 201
Worcester, MA 01605-1270

Phone

(617) 862-2196

Fax

(617) 862-2196

NPI assigned

Sep 9, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• FCP, Inc

  • Community/Behavioral Health Agency
  • Lawrence, MA
  • NPI 1992819411
  NPD
• Thrive Counseling LLC

  • Mental Health Counselor
  • Lynchburg, VA
  • NPI 1215181300
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1013522846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 GROVE ST STE 201",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016051270",
            "telephone_number": "617-862-2196",
            "fax_number": "617-862-2196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 GROVE ST STE 201",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016051270",
            "telephone_number": "617-862-2196",
            "fax_number": "617-862-2196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLAZO",
        "first_name": "MIRIAM",
        "middle_name": "DAMARIS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-09",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "LMHC10000359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.familycontinuity.org",
            "affiliation": "N",
            "address_1": "29 E Mountain St Ste 2",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "016061400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mairead Erin Coleman, CRNA
• Shauncey Coleman, MSW
• Chante Coddie-Anne Coley
• Katherine Colglazier
• Taylor Collado, CCC-SLP
• Brianna Colleary
• Collegial Psychiatry and Behavioral Medicine,Inc
• Peter J Colleran, PA-C
• Kathleen Colleton, A.M. SOCIAL SERVICE
• Alessandro Colletta

• Mental Health Counselor in Worcester, MA
• Providers in Worcester, MA by specialty
• Mental Health Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.