Provider Demographics
NPI:1821547696
Name:PERDOMO-JOHNSON, DORIS (LMFT)
Entity Type:Individual
Prefix:MS
First Name:DORIS
Middle Name:
Last Name:PERDOMO-JOHNSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SE 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1920
Mailing Address - Country:US
Mailing Address - Phone:954-463-2273
Mailing Address - Fax:954-779-1643
Practice Address - Street 1:101 SE 3RD AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1920
Practice Address - Country:US
Practice Address - Phone:954-463-2273
Practice Address - Fax:954-779-1643
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1910106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist