Provider Demographics
NPI:1386958049
Name:CORREA PERIN, VERONICA (PHD)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:CORREA PERIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:CORREA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2384 W AVENUE 134TH
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4133
Mailing Address - Country:US
Mailing Address - Phone:510-437-4968
Mailing Address - Fax:
Practice Address - Street 1:1411 E 31ST ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1018
Practice Address - Country:US
Practice Address - Phone:510-474-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28565103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical