Provider Demographics
NPI:1982390175
Name:COLON, WILMNELIZ (MA)
Entity Type:Individual
Prefix:MISS
First Name:WILMNELIZ
Middle Name:
Last Name:COLON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CARR 846 LOS ROSALES
Mailing Address - Street 2:APT 9
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-310-7654
Mailing Address - Fax:
Practice Address - Street 1:173 CALLE LIRIO
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-2212
Practice Address - Country:US
Practice Address - Phone:787-980-8151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6985103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling