Provider Demographics
NPI:1407827397
Name:PERONA, ARACELI ELISABET (PHD)
Entity Type:Individual
Prefix:
First Name:ARACELI
Middle Name:ELISABET
Last Name:PERONA
Suffix:
Gender:F
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:PMB 400 200 WESTERN AUTO PLAZA
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-391-0066
Mailing Address - Fax:
Practice Address - Street 1:359 SAN CLAUDIO AVE
Practice Address - Street 2:SUITE 309 A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-622-4433
Practice Address - Fax:787-822-4432
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2079103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
21446Medicare ID - Type Unspecified