Provider Demographics
NPI:1255663712
Name:COLON, WILFREDO (PSYD)
Entity type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:
Last Name:COLON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 AMATISTA URB BUCARE
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-245-0572
Mailing Address - Fax:787-998-4059
Practice Address - Street 1:3 CALLE AMATISTA URB BUCARE
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5116
Practice Address - Country:US
Practice Address - Phone:787-245-0572
Practice Address - Fax:787-998-4059
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3515103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical