Provider Demographics
NPI:1750359378
Name:COLON, ANGELITA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANGELITA
Middle Name:
Last Name:COLON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#107 ABERDEEN ST
Mailing Address - Street 2:COLLEGEVILLE
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4747
Mailing Address - Country:US
Mailing Address - Phone:939-642-7769
Mailing Address - Fax:
Practice Address - Street 1:AVE LAUREL 300
Practice Address - Street 2:LAUREL PLAZA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-288-0277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1963103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRP700OtherINTERNATIONAL MEDICAL CAR
PR56704OtherTRIPLE S, INC
PR56704OtherTRIPLE S, INC