Provider Demographics
NPI:1558801266
Name:NADAL COLON, MARIA DE LOURDES (PSY D)
Entity Type:Individual
Prefix:MRS
First Name:MARIA DE LOURDES
Middle Name:
Last Name:NADAL COLON
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A14 CALLE PALMA REAL
Mailing Address - Street 2:URB. SAGRADO CORAZON
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2548
Mailing Address - Country:US
Mailing Address - Phone:787-675-2261
Mailing Address - Fax:
Practice Address - Street 1:23 CALLE ALFONSO XII
Practice Address - Street 2:40 AVE PADRE NOEL
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-8034
Practice Address - Country:US
Practice Address - Phone:787-259-4463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5839103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical