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NPI Code Detail

MEDICARE: DR. ILENIA ALTAGRACIA PEREZ-PALEN PSYD

MEDICARE: DR. ILENIA ALTAGRACIA PEREZ-PALEN 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
1103TC0700XClinical Psychologist13070FL

General Provider Information

NPI Number : 1750067328
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ILENIA ALTAGRACIA PEREZ-PALEN PSYD
Provider Business Mailing Address
First Line : 300 CRITTENDEN BLVD
Second Line :
City : ROCHESTER
State : NY
Zip : 14642-0001
Country : US
Telephone Number : 585-275-3563
Fax Number :
Provider Business Practice Location Address
First Line : 300 CRITTENDEN BLVD
Second Line :
City : ROCHESTER
State : NY
Zip : 14642-0001
Country : US
Telephone Number : 585-275-3563
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2023
Last Update Date : 01/08/2026

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