Provider Demographics
NPI:1457529794
Name:COLON, MYRTEA CARMEN (MA)
Entity Type:Individual
Prefix:MRS
First Name:MYRTEA
Middle Name:CARMEN
Last Name:COLON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CAMINO LOS PIZARRO
Mailing Address - Street 2:COND. ALTURAS DE SAN JUAN, BOX 121
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7801
Mailing Address - Country:US
Mailing Address - Phone:787-249-7001
Mailing Address - Fax:787-292-0995
Practice Address - Street 1:11939 JAMES BAY DRIVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827
Practice Address - Country:US
Practice Address - Phone:787-249-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1760101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health