Healthcare Provider Details

I. General information

NPI: 1255675542
Provider Name (Legal Business Name): GLORYMAR CARRION-COLON MHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GLORYMAR CARRION-COLON MHC

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 LIBERTY ST
SPRINGFIELD MA
01104-3736
US

IV. Provider business mailing address

417 LIBERTY ST
SPRINGFIELD MA
01104-3736
US

V. Phone/Fax

Practice location:
  • Phone: 413-733-6661
  • Fax:
Mailing address:
  • Phone: 413-733-6661
  • 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: