Provider Demographics
NPI:1346973633
Name:COLON, CAMILLE MARIE (MPSY)
Entity Type:Individual
Prefix:MRS
First Name:CAMILLE
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:EST DE JUANA DIAZ
Mailing Address - Street 2:104 CALLE CEDRO
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795
Mailing Address - Country:US
Mailing Address - Phone:787-324-0223
Mailing Address - Fax:
Practice Address - Street 1:EST DE JUANA DIAZ
Practice Address - Street 2:104 CALLE CEDRO
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-324-0223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5653103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist