MEDICARE: LEISHKA MARIE PEREZ-NATER PSYD

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	103TH0100X	Health Service Psychologist	7409	PR
2	103TP2701X	Group Psychotherapy Psychologist	7409	PR
3	103TC1900X	Counseling Psychologist	7409	PR
4	103T00000X	Psychologist	7409	PR

General Provider Information

NPI Number	:	1730808544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEISHKA MARIE PEREZ-NATER PSYD

Provider Business Mailing Address
First Line	:	PO BOX 1029
Second Line	:
City	:	VEGA BAJA
State	:	PR
Zip	:	00694-1029
Country	:	US
Telephone Number	:	787-454-0839
Fax Number	:

Provider Business Practice Location Address
First Line	:	CALLE REINA ISABEL URB BAIROA AA-1
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725
Country	:	US
Telephone Number	:	787-923-5214
Fax Number	:

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

Provider Enumeration Date	:	08/24/2022
Last Update Date	:	06/13/2026

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