Provider Demographics
NPI:1225362270
Name:BUKIET, PEARL PENINA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PEARL
Middle Name:PENINA
Last Name:BUKIET
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:PEARL
Other - Middle Name:PENINA
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:315 E PALISADE AVEENUE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631
Mailing Address - Country:US
Mailing Address - Phone:201-569-9500
Mailing Address - Fax:
Practice Address - Street 1:315 E PALISADE AVEENUE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-569-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2023-06-08
Deactivation Date:2021-11-23
Deactivation Code:
Reactivation Date:2023-06-06
Provider Licenses
StateLicense IDTaxonomies
NY020391103T00000X
NY1378878103TS0200X
NJ35SI00669800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool