Provider Demographics
NPI:1124371760
Name:PEREZ, NELSON (LADC)
Entity Type:Individual
Prefix:MR
First Name:NELSON
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 KRYSTAL LN
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2623
Mailing Address - Country:US
Mailing Address - Phone:860-655-7160
Mailing Address - Fax:
Practice Address - Street 1:41 KRYSTAL LN
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2623
Practice Address - Country:US
Practice Address - Phone:860-655-7160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000488101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)