Provider Demographics
NPI:1831468222
Name:COLON, GLADYS MARGARITA (BA)
Entity Type:Individual
Prefix:MISS
First Name:GLADYS
Middle Name:MARGARITA
Last Name:COLON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 N SHORE DR NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-1460
Mailing Address - Country:US
Mailing Address - Phone:727-954-0473
Mailing Address - Fax:
Practice Address - Street 1:1120 N SHORE DR NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-1460
Practice Address - Country:US
Practice Address - Phone:727-954-0473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker