Provider Demographics
NPI:1992470934
Name:PERONACE, THERESA MARIA (LPC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIA
Last Name:PERONACE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 HARRIETT RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-8403
Mailing Address - Country:US
Mailing Address - Phone:267-251-7921
Mailing Address - Fax:
Practice Address - Street 1:2524 HUNTINGDON PIKE FL 1
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-6114
Practice Address - Country:US
Practice Address - Phone:267-251-7921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional