Provider Demographics
NPI:1649402694
Name:PERDOMO-OLMO, NYDIA E (MSW, ACSW)
Entity type:Individual
Prefix:MS
First Name:NYDIA
Middle Name:E
Last Name:PERDOMO-OLMO
Suffix:
Gender:F
Credentials:MSW, ACSW
Other - Prefix:MS
Other - First Name:NYDIA
Other - Middle Name:E
Other - Last Name:PERDOMO-OLMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, ACSW
Mailing Address - Street 1:HC 3 BOX 20630
Mailing Address - Street 2:BO. DOMINGUITO
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-8170
Mailing Address - Country:US
Mailing Address - Phone:787-467-2204
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 20630
Practice Address - Street 2:BO. DOMINGUITO
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-8170
Practice Address - Country:US
Practice Address - Phone:787-467-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR61431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical