Provider Demographics
NPI:1588146930
Name:PEROS, JOANNA (PSYD, RN)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:PEROS
Suffix:
Gender:F
Credentials:PSYD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 JUPITER LAKES BLVD STE 3102
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7189
Mailing Address - Country:US
Mailing Address - Phone:561-406-6561
Mailing Address - Fax:
Practice Address - Street 1:210 JUPITER LAKES BLVD. UNIT 3102
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:954-205-1455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-02
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7628103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical