Provider Demographics
NPI:1295384485
Name:MELENDEZ PEREZ, GLYSETH (LIC)
Entity Type:Individual
Prefix:
First Name:GLYSETH
Middle Name:
Last Name:MELENDEZ PEREZ
Suffix:
Gender:F
Credentials:LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TERRAZAS DEL TOA
Mailing Address - Street 2:3J 39 CALLE 32
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-384-3401
Mailing Address - Fax:
Practice Address - Street 1:BO ORTIZ
Practice Address - Street 2:LOTE 21 CARR 827 KM 4.1
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-384-3401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist