Provider Demographics
NPI:1417695164
Name:COLON RODRIGUEZ, JESMARIE (CPL)
Entity Type:Individual
Prefix:MS
First Name:JESMARIE
Middle Name:
Last Name:COLON RODRIGUEZ
Suffix:
Gender:F
Credentials:CPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 3502 SUITE 088
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795
Mailing Address - Country:US
Mailing Address - Phone:787-408-9586
Mailing Address - Fax:
Practice Address - Street 1:BO. RIO CANAS ARRIBA CALLE 4 #336
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-0079
Practice Address - Country:US
Practice Address - Phone:787-408-9586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4450101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional