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General NPI Number Information
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NPI Number | 1386068591
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Entity Type | Individual
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Provider Name | LUZ COLON ACEVEDO SR.
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Gender | Female
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Dates
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Enumeration Date | 02/07/2014
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Last Update Date | 02/07/2014
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Provider Practice Location Address
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Address Line | CALLE 4 PARCELAS NUEVAS 448 BO SAN JOSE
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City | TOA BAJA
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State | PR
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Zip | 00952
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Country | US
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Telephone | 939-232-8405
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 279 C/4 PARCELAS NUEVAS, NUM 448, BO. SAN JOSE 00949
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City | TOA BAJA
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State | PR
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Zip | 00951-0279
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Country | US
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Telephone | 939-232-8405
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 17805
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 17805
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License Number State | PR
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