Samiris Collazo-Rodriguez, PSY.D.
Individual provider Active NPI Counseling Psychologist · Juncos, PR
NPI 1639601495 · NPPES record last updated Feb 25, 2020
Key facts
- NPI
- 1639601495
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counseling Psychologist 103TC1900X
- License
- 5652 (PR)
- Practice address
- 51 Calle Escute
Juncos, PR 00777-3417 - Phone
- (787) 561-3585
- NPI assigned
- Mar 31, 2017
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171115001473 | PR | Practitioner - Psychologist Billing Independently | 7214293810 | Practice locations: Juncos, PR |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5652 | PR | MD | Obstetrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Servicios Psicologicos del Valenciano LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 5652 | PR | Yes |
Addresses
Primary practice location
51 Calle Escute
Juncos, PR 00777-3417
Mailing address
390 Calle Daguao
Urb Villas de Buenaventura
Yabucoa, PR 00767
Phone (787) 951-3858
Other providers in Juncos, PR
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- Clinica del Desarrollo de la Ninez Inc
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- Clinica Las Americas Guaynabo, Inc
- Genesis Collado Villafane
- Maria I Collazo
- Colon & Fernandez Acupuncture PSC
- Ismael Colon Calderon
- Alex Javier Colon
- Hector Manuel Colon
All providers in Juncos, PR · Counseling Psychologist in Puerto Rico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.