Provider Demographics
NPI:1518208529
Name:PEREZ, TANIA JULISSA
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:JULISSA
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 1:12 WOODBINE ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-2714
Mailing Address - Country:US
Mailing Address - Phone:508-847-0913
Mailing Address - Fax:
Practice Address - Street 1:360 MASSACHUSETTS AVE
Practice Address - Street 2:201
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3750
Practice Address - Country:US
Practice Address - Phone:978-935-3543
Practice Address - Fax:978-263-3088
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor