Healthcare Provider Details

I. General information

NPI: 1730808544
Provider Name (Legal Business Name): LEISHKA MARIE PEREZ-NATER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE REINA ISABEL URB BAIROA AA-1
CAGUAS PR
00725
US

IV. Provider business mailing address

PO BOX 1029
VEGA BAJA PR
00694-1029
US

V. Phone/Fax

Practice location:
  • Phone: 787-923-5214
  • Fax:
Mailing address:
  • Phone: 787-454-0839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number7409
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number7409
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7409
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number7409
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: