Individual
AWILDA PEREZ - LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
156 W 56TH ST STE 1804, NEW YORK, NY 10019-3878
(212) 851-8100
(212) 537-0102
Mailing address
240 MAIN ST APT 126, HACKENSACK, NJ 07601-5743
(201) 315-8140
Taxonomy
Speciality
Code
Description
License number
State
103TA0700X
Adult Development & Aging Psychologist
35SI100429700
NJ
103TC0700X
Clinical Psychologist
Primary
013880
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
013880
LICENSE
NJ
Enumeration date
07/05/2006
Last updated
07/21/2021
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