Provider Demographics
NPI:1902263874
Name:PERALTA MERCADO, JENIFER T
Entity Type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:T
Last Name:PERALTA MERCADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:T
Other - Last Name:PERALTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 ASHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-3239
Mailing Address - Country:US
Mailing Address - Phone:914-356-5953
Mailing Address - Fax:
Practice Address - Street 1:3 ASHWOOD LN
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-3239
Practice Address - Country:US
Practice Address - Phone:914-356-5953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-24
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst