Provider Demographics
NPI:1902215437
Name:PERALTA, ROBERT (MA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:PERALTA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR. ESTATAL 8860 KM. 1.2 PLAZA MATIENZO
Mailing Address - Street 2:BO. LAS CUEVAS SECTOR MATIENZO
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-633-6884
Mailing Address - Fax:
Practice Address - Street 1:CARR. ESTATAL 8860 KM. 1.2 PLAZA MATIENZO
Practice Address - Street 2:BO. LAS CUEVAS SECTOR MATIENZO
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-633-6884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3142103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling