MEDICARE: LUDGERIA JENNISE COLON-PABON LPC

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	101Y00000X	Counselor	2629	PR

General Provider Information

NPI Number	:	1114689445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUDGERIA JENNISE COLON-PABON LPC

Provider Business Mailing Address
First Line	:	3015 KIRKLAND ST
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32738-3135
Country	:	US
Telephone Number	:	787-390-7951
Fax Number	:

Provider Business Practice Location Address
First Line	:	7041 GRAND NATIONAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-8381
Country	:	US
Telephone Number	:	407-982-7718
Fax Number	:	407-704-5953

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

Provider Enumeration Date	:	10/13/2021
Last Update Date	:	10/13/2021

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Directions to “ LUDGERIA JENNISE COLON-PABON LPC” Practice Location

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