Provider Demographics
NPI:1306260922
Name:COLON, YADIRA SOSTRE (MSW)
Entity type:Individual
Prefix:
First Name:YADIRA
Middle Name:SOSTRE
Last Name:COLON
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:CARR. 805 KM 1.4
Mailing Address - Street 2:BO. NEGRO
Mailing Address - City:COROZAL
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00783
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 17335
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-9225
Practice Address - Country:US
Practice Address - Phone:787-312-3515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9433104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker