Provider Demographics
NPI:1568352128
Name:PERALTA, JENNIFER DENISE (CASAC-T)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DENISE
Last Name:PERALTA
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 E 176TH ST APT 215
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-6253
Mailing Address - Country:US
Mailing Address - Phone:917-659-7771
Mailing Address - Fax:917-659-7771
Practice Address - Street 1:480 E 176TH ST APT 215
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-6253
Practice Address - Country:US
Practice Address - Phone:917-659-7771
Practice Address - Fax:917-659-7771
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38054101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)