Provider Demographics
NPI:1518187665
Name:COLON, CARMEN C (PHD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:C
Last Name:COLON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVENIDA HOSTOS CONDOMINIO MONTE SUR
Mailing Address - Street 2:SECCION 180 APT. 520
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-751-3562
Mailing Address - Fax:787-751-3562
Practice Address - Street 1:AVENIDA HOSTOS CONDOMINIO MONTE SUR
Practice Address - Street 2:SECCION 180 APT. 520
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-751-3562
Practice Address - Fax:787-751-3562
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR664103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical