Provider Demographics
NPI:1841483617
Name:HERNANDEZ PEREZ, IRAIDA (MA)
Entity type:Individual
Prefix:
First Name:IRAIDA
Middle Name:
Last Name:HERNANDEZ PEREZ
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CALLE CENTRAL
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-8697
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 113.5
Practice Address - Street 2:EDIFICIO CENTERPLEX SUITE 103
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-8697
Practice Address - Country:US
Practice Address - Phone:787-819-5900
Practice Address - Fax:787-252-5523
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2860103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling