Active NPI
Lissette Heredia Perez, PSY D
- Psychologist
- Quebradillas, PR
National Provider Identifier
1619041472
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1443
- Practice address
- Carr #2 KM 101.5 Bo Terranova
Quebradillas, PR 00678 - Phone
- (787) 895-7915
- Fax
- (787) 895-7915
- NPI assigned
- Nov 20, 2006
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1443 | PR | Primary |
Addresses
Primary practice location
Carr #2 KM 101.5 Bo Terranova
Quebradillas, PR 00678
Mailing address
HC 02 Box 8516
Quebradillas, PR 00678
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080505000678 | PR | Practitioner - Psychologist Billing Independently | 6800975681 | Practice locations: Quebradillas, PR |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1443 | PR | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619041472",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "HC 02 BOX 8516",
"city": "QUEBRADILLAS",
"state": "PR",
"postal_code": "00678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CARR #2 KM 101.5 BO TERRANOVA",
"city": "QUEBRADILLAS",
"state": "PR",
"postal_code": "00678",
"telephone_number": "787-895-7915",
"fax_number": "787-895-7915"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEREDIA PEREZ",
"first_name": "LISSETTE",
"credential": "PSY D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PR",
"license": "1443",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Quebradillas, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.