Provider Demographics
NPI:1972285146
Name:COLON, JUAN IVAN (MSW, PHD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:IVAN
Last Name:COLON
Suffix:
Gender:M
Credentials:MSW, PHD
Other - Prefix:DR
Other - First Name:JUAN
Other - Middle Name:I
Other - Last Name:COLON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, PHD
Mailing Address - Street 1:T37 CALLE CASIA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-3233
Mailing Address - Country:US
Mailing Address - Phone:787-690-8026
Mailing Address - Fax:
Practice Address - Street 1:T37 CALLE CASIA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-3233
Practice Address - Country:US
Practice Address - Phone:787-690-8026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15995104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker