Provider Demographics
NPI:1326341892
Name:PERCZEK, RUBEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:
Last Name:PERCZEK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 NE 92ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-3132
Mailing Address - Country:US
Mailing Address - Phone:305-582-4689
Mailing Address - Fax:
Practice Address - Street 1:234 NE 92ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-3132
Practice Address - Country:US
Practice Address - Phone:305-582-4689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6311103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical