Provider Demographics
NPI:1710399670
Name:COLL, ELEANA (LCSW 87111)
Entity type:Individual
Prefix:
First Name:ELEANA
Middle Name:
Last Name:COLL
Suffix:
Gender:F
Credentials:LCSW 87111
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 LOS PRADOS ST APT 311
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2025
Mailing Address - Country:US
Mailing Address - Phone:754-229-5867
Mailing Address - Fax:
Practice Address - Street 1:3014 LOS PRADOS ST APT 311
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2025
Practice Address - Country:US
Practice Address - Phone:754-229-5867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA871111041C0700X
CA61196104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker