Provider Demographics
NPI:1891932323
Name:PERISSINOT-AMAR, ELIANA J
Entity Type:Individual
Prefix:
First Name:ELIANA
Middle Name:J
Last Name:PERISSINOT-AMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIANA
Other - Middle Name:
Other - Last Name:AMAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18459 PINES BLVD # 178
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1400
Mailing Address - Country:US
Mailing Address - Phone:954-410-3934
Mailing Address - Fax:
Practice Address - Street 1:18459 PINES BLVD#178
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1400
Practice Address - Country:US
Practice Address - Phone:954-410-3934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1951106H00000X
FL1-20-44799103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist