Provider Demographics
NPI:1245919984
Name:PEREZ RIVERA, SHERLY MARIE
Entity type:Individual
Prefix:
First Name:SHERLY
Middle Name:MARIE
Last Name:PEREZ RIVERA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 CALLE DE LA TANCA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-1412
Mailing Address - Country:US
Mailing Address - Phone:787-993-3585
Mailing Address - Fax:
Practice Address - Street 1:151 CALLE DE LA TANCA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-1412
Practice Address - Country:US
Practice Address - Phone:787-993-3585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8240103TC0700X
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program