Provider Demographics
NPI:1902253578
Name:PERERA, OLGA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:PERERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 W 76TH ST
Mailing Address - Street 2:APT 174
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3990
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1045 W 76TH ST
Practice Address - Street 2:APT 174
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-3990
Practice Address - Country:US
Practice Address - Phone:786-468-4779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-15-05779246Z00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-15-05779OtherREGISTERED BEHAVIOR TECHNICIAN