Provider Demographics
NPI:1982978912
Name:PEREZ, DENNISSE M (PHD)
Entity type:Individual
Prefix:DR
First Name:DENNISSE
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ALTURAS DE FLAMBOYAN 19 ST. GG-19
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-8066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:URB. ROOSEVELT 403 CALLE PEDRO ESPADA
Practice Address - Street 2:STE. 3
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918-2800
Practice Address - Country:US
Practice Address - Phone:787-294-6849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4164103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical