Provider Demographics
NPI:1568250926
Name:PEREZ, KATHERINE VALDERRAMA
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:VALDERRAMA
Last Name:PEREZ
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 1:312 NW 153RD AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1823
Mailing Address - Country:US
Mailing Address - Phone:954-868-7432
Mailing Address - Fax:954-868-7432
Practice Address - Street 1:312 NW 153RD AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1823
Practice Address - Country:US
Practice Address - Phone:954-868-7432
Practice Address - Fax:954-868-7432
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health