MEDICARE: MR. CALEB COLON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1033651708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CALEB COLON

Provider Business Mailing Address
First Line	:	12075 MAGAZINE ST
Second Line	:	APT. 12206
City	:	ORLANDO
State	:	FL
Zip	:	32828-5526
Country	:	US
Telephone Number	:	413-204-2726
Fax Number	:

Provider Business Practice Location Address
First Line	:	12075 MAGAZINE ST
Second Line	:	APT. 12206
City	:	ORLANDO
State	:	FL
Zip	:	32828-5526
Country	:	US
Telephone Number	:	413-204-2726
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2016
Last Update Date	:	11/13/2016

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