Provider Demographics
NPI:1265854368
Name:PERDOMO, BELIZA (LMFT)
Entity Type:Individual
Prefix:
First Name:BELIZA
Middle Name:
Last Name:PERDOMO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:BELIZA
Other - Middle Name:
Other - Last Name:RIDENOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:570 DIANA PL
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-4103
Mailing Address - Country:US
Mailing Address - Phone:818-312-6732
Mailing Address - Fax:
Practice Address - Street 1:150 S 6TH ST STE C1
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2057
Practice Address - Country:US
Practice Address - Phone:805-544-0815
Practice Address - Fax:805-476-1409
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT101761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7184OtherMEDI-CAL
CA7667OtherMEDI-CAL
CA7708OtherMEDI-CAL
CA7368OtherMEDI-CAL