Provider Demographics
NPI:1255138541
Name:BENZAQUEN PEROSA, JOAO PEDRO (PHD)
Entity type:Individual
Prefix:DR
First Name:JOAO PEDRO
Middle Name:
Last Name:BENZAQUEN PEROSA
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4271 MILLIKEN CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2532
Mailing Address - Country:US
Mailing Address - Phone:571-235-8263
Mailing Address - Fax:
Practice Address - Street 1:6840 STONEYBROOKE LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-1342
Practice Address - Country:US
Practice Address - Phone:703-598-2124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0733008439171M00000X
VA0704017493101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator