Provider Demographics
NPI:1275994238
Name:PERCELEANU, GUERGANA P (MSED)
Entity Type:Individual
Prefix:
First Name:GUERGANA
Middle Name:P
Last Name:PERCELEANU
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:GUERGANA
Other - Middle Name:P
Other - Last Name:BOYANOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7013 69TH PL
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-6641
Mailing Address - Country:US
Mailing Address - Phone:907-607-3285
Mailing Address - Fax:
Practice Address - Street 1:7013 69TH PL
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-6641
Practice Address - Country:US
Practice Address - Phone:907-607-3285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001732103K00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No252Y00000XAgenciesEarly Intervention Provider Agency