Provider Demographics
NPI:1235818436
Name:PEREZ RIVERA, JENNIFER MARIE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:PEREZ RIVERA
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 1:444 PARC IRIZARRY
Mailing Address - Street 2:
Mailing Address - City:ADJUNTAS
Mailing Address - State:PR
Mailing Address - Zip Code:00601
Mailing Address - Country:US
Mailing Address - Phone:939-366-0225
Mailing Address - Fax:
Practice Address - Street 1:GALERIA PROFESIONAL
Practice Address - Street 2:SUITE 102 CALLE CONCORDIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1562
Practice Address - Country:US
Practice Address - Phone:939-835-7257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
PR7729103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist