Provider Demographics
NPI:1689885667
Name:PEREZ-MADDELENA, YASMIN (LPC)
Entity Type:Individual
Prefix:
First Name:YASMIN
Middle Name:
Last Name:PEREZ-MADDELENA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:YASMIN
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:THERAPIST
Mailing Address - Street 1:968 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-1116
Mailing Address - Country:US
Mailing Address - Phone:203-332-3556
Mailing Address - Fax:203-382-1468
Practice Address - Street 1:1046 FAIRFIELD AVE
Practice Address - Street 2:1046 FAIRFIELD AVE
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-1116
Practice Address - Country:US
Practice Address - Phone:203-330-6054
Practice Address - Fax:203-331-4716
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002430106H00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist