Provider Demographics
NPI:1871160739
Name:COLON, ABDULLAH EMILIO
Entity type:Individual
Prefix:
First Name:ABDULLAH
Middle Name:EMILIO
Last Name:COLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 TALCOTTVILLE RD APT 7H
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-2344
Mailing Address - Country:US
Mailing Address - Phone:860-424-7080
Mailing Address - Fax:
Practice Address - Street 1:695 TALCOTTVILLE RD APT 7H
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-2344
Practice Address - Country:US
Practice Address - Phone:860-424-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT56961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical