Healthcare Provider Details

I. General information

NPI: 1942074497
Provider Name (Legal Business Name): MISS VIRNA L. COLON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 CONGRESS ST FL 5
BOSTON MA
02210-1218
US

IV. Provider business mailing address

66 N MAIN ST
SHARON MA
02067-1204
US

V. Phone/Fax

Practice location:
  • Phone: 617-790-4800
  • Fax:
Mailing address:
  • Phone: 787-614-0298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: