MEDICARE: JUAN PERALTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1184012288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN PERALTA

Provider Business Mailing Address
First Line	:	2120 E SERGEANT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-1729
Country	:	US
Telephone Number	:	646-327-2059
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 E SERGEANT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-1729
Country	:	US
Telephone Number	:	646-327-2059
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2014
Last Update Date	:	09/21/2024

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Directions to “ JUAN PERALTA ” Practice Location

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