Provider Demographics
NPI:1912419466
Name:COLON, LUIS (MSW)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:COLON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 PARK AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1958
Mailing Address - Country:US
Mailing Address - Phone:508-753-2900
Mailing Address - Fax:
Practice Address - Street 1:255 PARK AVE STE 500
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1958
Practice Address - Country:US
Practice Address - Phone:508-753-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker