Provider Demographics
NPI:1720298466
Name:PEREZ, ALICE GEANNY (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:GEANNY
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:304 CALLE AZALEA
Mailing Address - Street 2:VALLE ESCONDIDO
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-8727
Mailing Address - Country:US
Mailing Address - Phone:787-768-3320
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA SANCHEZ OSORIO 5H4
Practice Address - Street 2:VILLA FONTANA PARK
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00988
Practice Address - Country:US
Practice Address - Phone:787-768-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1926103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7873OtherFIRST MEDICAL
PR457101OtherFHC
PR1645OtherAPS
PR61364OtherTRIPLE S