Provider Demographics
NPI:1134477755
Name:PEREZ BADILLO, LUDITZA
Entity Type:Individual
Prefix:
First Name:LUDITZA
Middle Name:
Last Name:PEREZ BADILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1308
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-1308
Mailing Address - Country:US
Mailing Address - Phone:787-508-8259
Mailing Address - Fax:787-868-4720
Practice Address - Street 1:CARRETERA 115 KM 22 4
Practice Address - Street 2:BARRIO GUAYABO SECTOR CASUALIDAD
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-0000
Practice Address - Country:US
Practice Address - Phone:787-312-1854
Practice Address - Fax:787-551-7316
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4311103TF0000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily