Provider Demographics
NPI:1194976522
Name:COLON, GLENDA (MTS)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:COLON
Suffix:
Gender:F
Credentials:MTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB SANTA ROSA CALLE 20
Mailing Address - Street 2:BLQ 25 NUM 20
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-6555
Mailing Address - Country:US
Mailing Address - Phone:787-448-3156
Mailing Address - Fax:
Practice Address - Street 1:CENTRO DE SALUD MENTAL DE BAYAMON
Practice Address - Street 2:APTDO 4258 BAYAMON GARDENS STATION
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00958
Practice Address - Country:US
Practice Address - Phone:787-786-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9639104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker