Provider Demographics
NPI:1063643609
Name:COLORADO, ANTONIO J III (MA)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:J
Last Name:COLORADO
Suffix:III
Gender:M
Credentials:MA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 367221
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-7221
Mailing Address - Country:US
Mailing Address - Phone:787-753-9515
Mailing Address - Fax:787-296-1691
Practice Address - Street 1:405 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3014
Practice Address - Country:US
Practice Address - Phone:787-753-9515
Practice Address - Fax:787-296-1691
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR1849103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling