Provider Demographics
NPI:1477234599
Name:PEREZ, SOPHIA M
Entity Type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SOPHIA
Other - Middle Name:M
Other - Last Name:MCEWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYM-ABA
Mailing Address - Street 1:681 SUNDIAL CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46231-1194
Mailing Address - Country:US
Mailing Address - Phone:517-214-5089
Mailing Address - Fax:
Practice Address - Street 1:2399 E WALTON BLVD
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-1955
Practice Address - Country:US
Practice Address - Phone:248-475-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator