Provider Demographics
NPI:1205407053
Name:CORREA PEREZ, DENISSE
Entity Type:Individual
Prefix:
First Name:DENISSE
Middle Name:
Last Name:CORREA PEREZ
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 1:1655 S FLORIDA MANGO RD APT 11
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-8905
Mailing Address - Country:US
Mailing Address - Phone:561-293-1275
Mailing Address - Fax:
Practice Address - Street 1:1655 S FLORIDA MANGO RD APT 11
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-8905
Practice Address - Country:US
Practice Address - Phone:561-293-1275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-173955106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician