Provider Demographics
NPI:1649555186
Name:COLON BONES, JESSENIA (PHD)
Entity type:Individual
Prefix:MISS
First Name:JESSENIA
Middle Name:
Last Name:COLON BONES
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 1:1606 GAINES MILL CT APT 102
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5193
Mailing Address - Country:US
Mailing Address - Phone:787-404-9618
Mailing Address - Fax:833-901-2937
Practice Address - Street 1:1606 GAINES MILL CT APT 102
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-5193
Practice Address - Country:US
Practice Address - Phone:787-404-9618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY12106103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3993OtherPSYCHOLOGIST