Provider Demographics
NPI:1881092062
Name:COLON, IVO A (LCSW,CAADC)
Entity type:Individual
Prefix:
First Name:IVO
Middle Name:A
Last Name:COLON
Suffix:
Gender:M
Credentials:LCSW,CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BLACKHORSE HILL RD BLDG 39B
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-2096
Mailing Address - Country:US
Mailing Address - Phone:610-384-7711
Mailing Address - Fax:610-466-2207
Practice Address - Street 1:1400 BLACKHORSE HILL RD BLDG 39B
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-2096
Practice Address - Country:US
Practice Address - Phone:610-384-7711
Practice Address - Fax:610-466-2207
Is Sole Proprietor?:No
Enumeration Date:2014-12-19
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical