Provider Demographics
NPI:1093256018
Name:COLON ORTIZ, KAROL S (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAROL
Middle Name:S
Last Name:COLON ORTIZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101027 CALLE ESTRELLA
Mailing Address - Street 2:URB. ALTURAS DEL ALBA
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-2350
Mailing Address - Country:US
Mailing Address - Phone:787-598-9313
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO SAN GERARDO SUITE 207G
Practice Address - Street 2:CARR 149 KM 58
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-598-9313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5849103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical