Provider Demographics
NPI:1366165201
Name:PEREIRA-ROMERO, JOANNA M (MCPL)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:PEREIRA-ROMERO
Suffix:
Gender:F
Credentials:MCPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2086
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-2086
Mailing Address - Country:US
Mailing Address - Phone:939-645-0391
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 967 KM. 1.3
Practice Address - Street 2:SECTOR LAS 3T
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-2086
Practice Address - Country:US
Practice Address - Phone:939-645-0391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2109101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional