Provider Demographics
NPI:1114618964
Name:PEREZ, SAMARA ISABELLA
Entity Type:Individual
Prefix:
First Name:SAMARA
Middle Name:ISABELLA
Last Name:PEREZ
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 1:1601 SPRING GARDEN ST APT M102
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3941
Mailing Address - Country:US
Mailing Address - Phone:732-713-5570
Mailing Address - Fax:
Practice Address - Street 1:123 CHESTNUT ST STE 304
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3059
Practice Address - Country:US
Practice Address - Phone:215-399-4128
Practice Address - Fax:215-399-4128
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor