Provider Demographics
NPI:1194955708
Name:COLON-GONZALEZ, REINA D (MSW)
Entity type:Individual
Prefix:MS
First Name:REINA
Middle Name:D
Last Name:COLON-GONZALEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 CALLE PADRE RIVERA
Mailing Address - Street 2:URB. LA INMACULADA
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-5834
Mailing Address - Country:US
Mailing Address - Phone:787-390-5364
Mailing Address - Fax:787-915-6830
Practice Address - Street 1:405 CALLE PADRE RIVERA
Practice Address - Street 2:URB. LA INMACULADA
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-5834
Practice Address - Country:US
Practice Address - Phone:787-390-5364
Practice Address - Fax:787-915-6830
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR38151041C0700X
PR16461041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool