Individual provider Active NPI

Jessica Gomez Perales, PSY.D

  • Clinical Psychologist
  • San Juan, PR
National Provider Identifier
1194001933
Registry record updated Mar 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
4121 Issued in PR
Practice address
29 Calle Washington Ste 107
San Juan, PR 00907-1509
Phone
(787) 466-0106
NPI assigned
Oct 25, 2011
Last updated
Mar 23, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 23, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 4121 PR
Addiction (Substance Use Disorder) Psychologist 103TA0400X 4121 PR
Adult Development & Aging Psychologist 103TA0700X 4121 PR
Cognitive & Behavioral Psychologist 103TB0200X NU
Clinical Psychologist 103TC0700X 4121 PR Primary
Clinical Child & Adolescent Psychologist 103TC2200X NU
Family Psychologist 103TF0000X NU
Family Psychologist 103TF0000X 4121 PR
Health Service Psychologist 103TH0100X NU
Intellectual & Developmental Disabilities Psychologist 103TM1800X NU
Group Psychotherapy Psychologist 103TP2701X NU
Group Psychotherapy Psychologist 103TP2701X 4121 PR
Rehabilitation Psychologist 103TR0400X NU
Health Psychologist 103TH0004X NU
Health Psychologist 103TH0004X 4121 PR

Addresses

Primary practice location

29 Calle Washington Ste 107
San Juan, PR 00907-1509

Mailing address

29 Calle Washington Ste 107
San Juan, PR 00907-1509
Phone (787) 466-0106

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
4121PRMDAdult Development & Aging Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1319500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521763200000",
    "number": "1194001933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 CALLE WASHINGTON STE 107",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009071509",
            "telephone_number": "787-466-0106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 CALLE WASHINGTON STE 107",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009071509",
            "telephone_number": "787-466-0106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ PERALES",
        "first_name": "JESSICA",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-10-25",
        "last_updated": "2018-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PR",
            "license": "4121",
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "PR",
            "license": "4121",
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "PR",
            "license": "4121",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PR",
            "license": "4121",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "PR",
            "license": "4121",
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "PR",
            "license": "4121",
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "PR",
            "license": "4121",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.