Provider Demographics
NPI:1609256247
Name:COLTON-RIVERA, MILDRED
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:COLTON-RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MILDRED
Other - Middle Name:
Other - Last Name:COLTON-RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPL
Mailing Address - Street 1:PO BOX 1913
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-1913
Mailing Address - Country:US
Mailing Address - Phone:787-585-2102
Mailing Address - Fax:
Practice Address - Street 1:75-42 AVE RAMON LUIS RIVERA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-585-2102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2218101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional