Provider Demographics
NPI:1508619388
Name:PERERA, ERIKA VENEDICE (PPS)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:VENEDICE
Last Name:PERERA
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:VENEDICE
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PPS
Mailing Address - Street 1:850 E COLTON AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-3699
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 E COLTON AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-3635
Practice Address - Country:US
Practice Address - Phone:909-307-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230013243101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool