Active NPI
Marisa Judith Perera, PHD
- Clinical Psychologist
- Coral Gables, FL
National Provider Identifier
1295472231
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 11293
- Practice address
- 3081 Salzedo St Ste 202
Coral Gables, FL 33134-6725 - Phone
- (305) 204-8292
- NPI assigned
- May 19, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 11293 | FL | Primary |
Addresses
Primary practice location
3081 Salzedo St Ste 202
Coral Gables, FL 33134-6725
Mailing address
7901 4TH St N Ste 300
St Petersburg, FL 33702-4399
Phone (305) 204-8292
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11293 | Other | FL | FLORIDA PSYCHOLOGY LICENSE |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 11293 | FL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674604800000",
"number": "1295472231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7901 4TH ST N STE 300",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337024399",
"telephone_number": "305-204-8292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3081 SALZEDO ST STE 202",
"city": "CORAL GABLES",
"state": "FL",
"postal_code": "331346725",
"telephone_number": "305-204-8292"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERERA",
"first_name": "MARISA",
"middle_name": "JUDITH",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-19",
"last_updated": "2023-01-25",
"certification_date": "2023-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "11293",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FLORIDA PSYCHOLOGY LICENSE",
"identifier": "11293",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coral Gables, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.