MEDICARE: MR. HECTOR JUAN COLON MSW

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1386785848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HECTOR JUAN COLON MSW

Provider Business Mailing Address
First Line	:	1601 JOHNS LAKE RD
Second Line	:	#1021
City	:	CLERMONT
State	:	FL
Zip	:	34711-6655
Country	:	US
Telephone Number	:	407-404-4754
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 N WYMORE RD
Second Line	:	SUITE 200
City	:	WINTER PARK
State	:	FL
Zip	:	32789-2808
Country	:	US
Telephone Number	:	407-975-2665
Fax Number	:

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/08/2007

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