Provider Demographics
NPI:1689161374
Name:COLON DE LEON, ENRIQUE L (PSYCHOLOGY DOCTOR)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:L
Last Name:COLON DE LEON
Suffix:
Gender:M
Credentials:PSYCHOLOGY DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11752
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-2852
Mailing Address - Country:US
Mailing Address - Phone:787-639-3231
Mailing Address - Fax:
Practice Address - Street 1:607 CALLE JULIO GONZALEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3717
Practice Address - Country:US
Practice Address - Phone:787-639-3231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2954103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling