Provider Demographics
NPI:1194436386
Name:PEREZ RIVERA, MARYLIN JAZMIN (LICENCIADA(LCDA))
Entity type:Individual
Prefix:MRS
First Name:MARYLIN
Middle Name:JAZMIN
Last Name:PEREZ RIVERA
Suffix:
Gender:F
Credentials:LICENCIADA(LCDA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC-01 BOX 8554
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-9569
Mailing Address - Country:US
Mailing Address - Phone:787-536-9147
Mailing Address - Fax:
Practice Address - Street 1:BO. JUAN MARTIN CARR 3 KM 42.1
Practice Address - Street 2:
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773-9569
Practice Address - Country:US
Practice Address - Phone:787-536-9147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004377103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling