Provider Demographics
NPI:1790210086
Name:PEREZ CARDENAS, LIDICE
Entity Type:Individual
Prefix:
First Name:LIDICE
Middle Name:
Last Name:PEREZ CARDENAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8421 NW 8TH ST APT 210
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3722
Mailing Address - Country:US
Mailing Address - Phone:866-264-4097
Mailing Address - Fax:
Practice Address - Street 1:8421 NW 8TH ST APT 210
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3722
Practice Address - Country:US
Practice Address - Phone:866-264-4097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst