Provider Demographics
NPI:1043747207
Name:PEREZ DE PONCE, NAYDA LUISA (MA, PLMHP, NCC)
Entity Type:Individual
Prefix:
First Name:NAYDA
Middle Name:LUISA
Last Name:PEREZ DE PONCE
Suffix:
Gender:F
Credentials:MA, PLMHP, NCC
Other - Prefix:
Other - First Name:NAYDA
Other - Middle Name:LUISA
Other - Last Name:PEREZ CABAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14421 DUPONT CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2100
Mailing Address - Country:US
Mailing Address - Phone:402-884-6400
Mailing Address - Fax:402-504-6614
Practice Address - Street 1:14421 DUPONT CT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2100
Practice Address - Country:US
Practice Address - Phone:402-884-6400
Practice Address - Fax:402-504-6614
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10981101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health