Provider Demographics
NPI:1538299839
Name:PEREZ, JOALENNY (PSYD)
Entity Type:Individual
Prefix:
First Name:JOALENNY
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 CALLE PASADENA
Mailing Address - Street 2:RIO PIEDRAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3432
Mailing Address - Country:US
Mailing Address - Phone:787-568-2044
Mailing Address - Fax:
Practice Address - Street 1:312 CALLE PASADENA
Practice Address - Street 2:RIO PIEDRAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3432
Practice Address - Country:US
Practice Address - Phone:787-568-2044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2780103T00000X, 103TC0700X, 103TC2200X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic