Provider Demographics
NPI:1134672876
Name:PEREZ, CHANTELL
Entity Type:Individual
Prefix:
First Name:CHANTELL
Middle Name:
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 1:3551 SW 9 TERR
Mailing Address - Street 2:APT: 411
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4360
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3551 SW 9 TERR
Practice Address - Street 2:APT: 411
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4360
Practice Address - Country:US
Practice Address - Phone:305-951-9482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst