Provider Demographics
NPI:1265987606
Name:PEREZ, VANESSA DANIELLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:DANIELLE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9960 NW 116TH WAY
Mailing Address - Street 2:SUITE 12
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1167
Mailing Address - Country:US
Mailing Address - Phone:305-332-4972
Mailing Address - Fax:
Practice Address - Street 1:9960 NW 116TH WAY
Practice Address - Street 2:SUITE 12
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33178-1167
Practice Address - Country:US
Practice Address - Phone:305-332-4972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9516103T00000X, 103TA0700X, 103TB0200X, 103TC0700X, 103TC1900X, 103TF0000X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic