Provider Demographics
NPI:1265866842
Name:PEREZ, PERLA (SERVICE COORDINATOR)
Entity Type:Individual
Prefix:
First Name:PERLA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:SERVICE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 RICHMOND AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1520
Mailing Address - Country:US
Mailing Address - Phone:718-556-1616
Mailing Address - Fax:718-442-9962
Practice Address - Street 1:1535 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1520
Practice Address - Country:US
Practice Address - Phone:718-556-1616
Practice Address - Fax:718-442-9962
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional