Provider Demographics
NPI:1417657461
Name:SANTIAGO COLON, CARLOS MANUEL (PSYD)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:MANUEL
Last Name:SANTIAGO COLON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10244 E COLONIAL DR STE 110
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-4365
Mailing Address - Country:US
Mailing Address - Phone:407-202-9440
Mailing Address - Fax:407-601-6879
Practice Address - Street 1:10244 E COLONIAL DR STE 110
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-4365
Practice Address - Country:US
Practice Address - Phone:407-202-9440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist