Healthcare Provider Details

I. General information

NPI: 1891625612
Provider Name (Legal Business Name): JOSE COLLADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S STATE ST STE 3
CLARKS SUMMIT PA
18411-1590
US

IV. Provider business mailing address

320 S STATE ST STE 3
CLARKS SUMMIT PA
18411-1590
US

V. Phone/Fax

Practice location:
  • Phone: 570-290-8603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW144156
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: