Provider Demographics
NPI:1316277221
Name:BIASCOECHEA-PEREDA, MIRIAM (PHD)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:BIASCOECHEA-PEREDA
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 1:101 QUENEPA ST., MILAVILLE
Mailing Address - Street 2:
Mailing Address - City:SANJUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5113
Mailing Address - Country:US
Mailing Address - Phone:787-790-3548
Mailing Address - Fax:
Practice Address - Street 1:1608 CALLE BORI
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6100
Practice Address - Country:US
Practice Address - Phone:787-282-0501
Practice Address - Fax:787-282-9063
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional