Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 899 | PR |
Y | 103TS0200X | School Psychologist | 3630 | PR |
NPI | 1124334727 |
---|---|
Provider Name | Jaclyn Perez |
First Address | Vega Alta, PR 00692-5835 |
Second Address | Vega Alta, PR 00692-5835 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2010 |
Last Update Date | 20/08/2010 |