Provider Demographics
NPI:1396756490
Name:PEREYRA, ROSALIA NOEMI (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROSALIA
Middle Name:NOEMI
Last Name:PEREYRA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14831 S 19TH WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-4164
Mailing Address - Country:US
Mailing Address - Phone:602-314-4475
Mailing Address - Fax:602-680-3318
Practice Address - Street 1:3507 N CENTRAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2121
Practice Address - Country:US
Practice Address - Phone:602-314-4475
Practice Address - Fax:602-680-3318
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3666103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ137245Medicaid
AZ137245OtherAHCCCS
AZ11725808OtherCAQH
AZ114288Medicare PIN
AZ11725808OtherCAQH