Provider Demographics
NPI:1871361170
Name:PEREZ GONZALEZ, GLARIBETH
Entity type:Individual
Prefix:
First Name:GLARIBETH
Middle Name:
Last Name:PEREZ GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 CALLE CELSO BARBOSA
Mailing Address - Street 2:BARRIO PUEBLO
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676
Mailing Address - Country:US
Mailing Address - Phone:939-496-3465
Mailing Address - Fax:
Practice Address - Street 1:CARR 125 KM 3
Practice Address - Street 2:BARRIO PUEBLO
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:939-496-3465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006442103TF0000X
PR006542103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR006542OtherLICENCIA