Provider Demographics
NPI:1346588837
Name:PEREZ, ANDRES (BA)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 VARNUM AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-2119
Mailing Address - Country:US
Mailing Address - Phone:978-322-5095
Mailing Address - Fax:978-322-5097
Practice Address - Street 1:391 VARNUM AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2119
Practice Address - Country:US
Practice Address - Phone:978-322-5095
Practice Address - Fax:978-322-5097
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health