Provider Demographics
NPI:1730841826
Name:PERERA, SHANA (LMHC)
Entity type:Individual
Prefix:MS
First Name:SHANA
Middle Name:
Last Name:PERERA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 NW 7TH ST APT 104
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2219
Mailing Address - Country:US
Mailing Address - Phone:786-356-0160
Mailing Address - Fax:
Practice Address - Street 1:1599 SW 187TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33194-2801
Practice Address - Country:US
Practice Address - Phone:305-480-4339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health