Provider Demographics
NPI:1750629598
Name:COLON, CLARA (PHD)
Entity Type:Individual
Prefix:MRS
First Name:CLARA
Middle Name:
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:E-11 MARGINAL
Mailing Address - Street 2:URB. ANAIDA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2573
Mailing Address - Country:US
Mailing Address - Phone:787-259-7528
Mailing Address - Fax:
Practice Address - Street 1:E11 CALLE MARGINAL
Practice Address - Street 2:URB ANAIDA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2558
Practice Address - Country:US
Practice Address - Phone:787-259-7528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR613103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical