Provider Demographics
NPI:1477095511
Name:PERLAZA, SUSAN KAREN (MA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KAREN
Last Name:PERLAZA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6325 DRY HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1964
Mailing Address - Country:US
Mailing Address - Phone:718-639-9750
Mailing Address - Fax:
Practice Address - Street 1:6325 DRY HARBOR RD
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1964
Practice Address - Country:US
Practice Address - Phone:718-639-9750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool