Provider Demographics
NPI:1265840441
Name:PEREZ-STRUMOLO, LYSANDRA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYSANDRA
Middle Name:M
Last Name:PEREZ-STRUMOLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1311
Mailing Address - Country:US
Mailing Address - Phone:862-377-4267
Mailing Address - Fax:
Practice Address - Street 1:225 ROUTE 23 NORTH
Practice Address - Street 2:SUITE 2B
Practice Address - City:HAMBURG
Practice Address - State:NJ
Practice Address - Zip Code:07419
Practice Address - Country:US
Practice Address - Phone:973-864-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTP#143-048103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical