Provider Demographics
NPI:1972757169
Name:PEREZ PEREZ, LYDIA VANESSA
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:VANESSA
Last Name:PEREZ PEREZ
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:URB. EL VALLE
Mailing Address - Street 2:CALLE ALAMO 111
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667
Mailing Address - Country:US
Mailing Address - Phone:787-538-3958
Mailing Address - Fax:
Practice Address - Street 1:EMPORIUM I SUITE 203
Practice Address - Street 2:ROAD PR 2 KM 1565
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-376-7589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2024103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical