Provider Demographics
NPI:1992385249
Name:AVILES PEREZ, DARLENE (LMFT)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:AVILES PEREZ
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 1:42 E FRONT ST OFC 4
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2942
Mailing Address - Country:US
Mailing Address - Phone:484-868-9926
Mailing Address - Fax:
Practice Address - Street 1:42 E FRONT ST OFC 4
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2942
Practice Address - Country:US
Practice Address - Phone:484-868-9926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001163106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist