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General NPI Number Information
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NPI Number | 1770030173
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Entity Type | Individual
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Provider Name | KEYSHLA MARIE COLON TORRES LCSWA
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Gender | Female
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Dates
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Enumeration Date | 09/02/2016
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 130 CARBONTON RD
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City | SANFORD
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State | NC
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Zip | 27330-4009
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Country | US
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Telephone | 787-579-6831
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Fax |
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Provider Business Mailing Address
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Address Line | 675 PONDEROSA TRL
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City | CAMERON
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State | NC
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Zip | 28326-9745
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Country | US
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Telephone | 787-579-6831
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 13383
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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 |
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License Number State |
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