Provider Demographics
NPI:1891310397
Name:COLON-MOLINA, JENIZARET (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENIZARET
Middle Name:
Last Name:COLON-MOLINA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JENIZARET
Other - Middle Name:
Other - Last Name:COLON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:THANATOLOGY
Mailing Address - Street 1:48 AVE. LUIS MUNOZ RIVERA, CAMUY P.R. 00627
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627
Mailing Address - Country:US
Mailing Address - Phone:939-263-0571
Mailing Address - Fax:
Practice Address - Street 1:48 AVE. LUIS MUNOZ RIVERA, CAMUY P.R. 00627
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:939-263-0571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6754103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical