Provider Demographics
NPI:1275831315
Name:COLON, YARELIS MARIE (MPSY)
Entity Type:Individual
Prefix:
First Name:YARELIS
Middle Name:MARIE
Last Name:COLON
Suffix:
Gender:F
Credentials:MPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 4082
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-7005
Mailing Address - Country:US
Mailing Address - Phone:787-234-4015
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 4082
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-7005
Practice Address - Country:US
Practice Address - Phone:787-234-4015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-13
Last Update Date:2011-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3516103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist