Healthcare Provider Details

I. General information

NPI: 1114491123
Provider Name (Legal Business Name): AMANDA COLON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 PARK CENTER DR STE 270
ORLANDO FL
32835-7608
US

IV. Provider business mailing address

2101 PARK CENTER DR STE 270
ORLANDO FL
32835-7608
US

V. Phone/Fax

Practice location:
  • Phone: 407-523-1213
  • Fax:
Mailing address:
  • Phone: 407-523-1213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904016387
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW18305
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: