Provider Demographics
NPI:1316769748
Name:PEREZ, DEYMAR (LIC)
Entity type:Individual
Prefix:MISS
First Name:DEYMAR
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 PASEO DE SOTOMAYOR
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-2636
Mailing Address - Country:US
Mailing Address - Phone:939-224-9877
Mailing Address - Fax:
Practice Address - Street 1:13 PASEO DE SOTOMAYOR
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-2636
Practice Address - Country:US
Practice Address - Phone:939-224-9877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7727103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist