Provider Demographics
NPI:1255007928
Name:COLON, KEIRY J
Entity Type:Individual
Prefix:
First Name:KEIRY
Middle Name:J
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 1:56 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-7015
Mailing Address - Country:US
Mailing Address - Phone:401-209-0576
Mailing Address - Fax:
Practice Address - Street 1:56 HUDSON ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-7015
Practice Address - Country:US
Practice Address - Phone:401-209-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-21
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW20574440OtherAETNA