Individual provider Active NPI

Lissette Collazo

  • Behavior Analyst
  • Lake Worth, FL
National Provider Identifier
1629358577
Registry record updated Aug 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Practice address
10640 Paso Fino Dr
Lake Worth, FL 33449-8018
Phone
(561) 667-2705
Fax
(561) 444-2458
NPI assigned
Aug 24, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X Primary
Clinical Social Worker 1041C0700X

Addresses

Primary practice location

10640 Paso Fino Dr
Lake Worth, FL 33449-8018

Mailing address

10640 Paso Fino Dr
Wellington, FL 33449-8018
Phone (561) 667-2705

Other practice location 1

1876 Baythorne Rd
West Palm Beach, FL 33415-6306
Phone (561) 667-2705

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Brighter Minds Behavioral Health, LLC. Behavior Analyst Current Accepting new patients
Rainbow of Life Behavioral Health Center, LLC Behavior Analyst CurrentSince Aug 1, 2022 Accepting new patients

Locations

2115 10th Ave N
Lake Worth Beach, FL 33461
Phone (561) 506-3665

2119 10th Ave N
Lake Worth Beach, FL 33461
Phone (561) 444-2814

1521 Forest Hill Blvd
Ste 3B
West Palm Beach, FL 33406
Phone (561) 506-3665

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1314144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785888000000",
    "number": "1629358577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10640 PASO FINO DR",
            "city": "WELLINGTON",
            "state": "FL",
            "postal_code": "334498018",
            "telephone_number": "561-667-2705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10640 PASO FINO DR",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334498018",
            "telephone_number": "561-667-2705",
            "fax_number": "561-444-2458"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1876 Baythorne Rd",
            "address_purpose": "LOCATION",
            "city": "West Palm Beach",
            "state": "FL",
            "postal_code": "334156306",
            "country_code": "US",
            "telephone_number": "561-667-2705",
            "fax_number": "561-444-2458",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COLLAZO",
        "first_name": "LISSETTE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-24",
        "last_updated": "2026-08-05",
        "certification_date": "2026-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Worth, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.