Provider Demographics
NPI:1528207396
Name:KALLIS COLON, ISABELLE (PHD)
Entity Type:Individual
Prefix:
First Name:ISABELLE
Middle Name:
Last Name:KALLIS 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 1:1600 AVE PONCE DE LEON
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00909-1844
Mailing Address - Country:US
Mailing Address - Phone:787-724-9797
Mailing Address - Fax:787-724-9700
Practice Address - Street 1:1600 AVE PONCE DE LEON
Practice Address - Street 2:1ST FLOOR
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-1844
Practice Address - Country:US
Practice Address - Phone:787-724-9797
Practice Address - Fax:787-724-9700
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3244103T00000X, 103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical