Provider Demographics
NPI:1780552125
Name:PERDOMO DOMINGUEZ, GLENDY DE LA CARIDAD
Entity type:Individual
Prefix:
First Name:GLENDY
Middle Name:DE LA CARIDAD
Last Name:PERDOMO DOMINGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9531 FONTAINEBLEAU BLVD APT 209
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-6830
Mailing Address - Country:US
Mailing Address - Phone:786-614-1535
Mailing Address - Fax:
Practice Address - Street 1:9531 FONTAINEBLEAU BLVD APT 209
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-6830
Practice Address - Country:US
Practice Address - Phone:786-614-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician