Provider Demographics
NPI:1497593651
Name:COLON, JOAN MARIE
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE
Last Name:COLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAN ALFONSO D12 CALLE MIS AMORES
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-5821
Mailing Address - Country:US
Mailing Address - Phone:787-930-3144
Mailing Address - Fax:
Practice Address - Street 1:14 CARR PR 3
Practice Address - Street 2:SAN VICENTE MALL SECTOR MELANIA BO. JOBOS
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-558-8718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7932103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool