Provider Demographics
NPI:1912250259
Name:COLON JIMENEZ, RAQUEL MARIE (MSWC)
Entity Type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:MARIE
Last Name:COLON JIMENEZ
Suffix:
Gender:F
Credentials:MSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 11 I18
Mailing Address - Street 2:ALTA VISTA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-901-1216
Mailing Address - Fax:
Practice Address - Street 1:CALLE11 I 18
Practice Address - Street 2:ALTA VISTA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-901-1216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR104041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical