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General NPI Number Information
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NPI Number | 1891932323
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Entity Type | Individual
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Provider Name | ELIANA J. PERISSINOT-AMAR
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Gender | Female
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Dates
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Enumeration Date | 01/21/2009
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Last Update Date | 09/13/2021
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Provider Practice Location Address
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Address Line | 18459 PINES BLVD#178
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-1400
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Country | US
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Telephone | 954-410-3934
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Fax |
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Provider Business Mailing Address
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Address Line | 18459 PINES BLVD # 178
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-1400
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Country | US
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Telephone | 954-410-3934
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT1951
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-44799
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License Number State | FL
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