Provider Demographics
NPI:1346766631
Name:PERDOMO, MARLEN ESTHER
Entity Type:Individual
Prefix:
First Name:MARLEN
Middle Name:ESTHER
Last Name:PERDOMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARLEN
Other - Middle Name:ESTHER
Other - Last Name:PERDOMO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9110 146TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-4301
Mailing Address - Country:US
Mailing Address - Phone:718-468-9000
Mailing Address - Fax:
Practice Address - Street 1:91-10 146TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435
Practice Address - Country:US
Practice Address - Phone:718-468-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool