Provider Demographics
NPI:1578926432
Name:PEREZ, CHRISTINA
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
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 1:223 LOWREY PL
Mailing Address - Street 2:APT. 3
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-3008
Mailing Address - Country:US
Mailing Address - Phone:860-385-3383
Mailing Address - Fax:
Practice Address - Street 1:225 N MAIN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4926
Practice Address - Country:US
Practice Address - Phone:860-585-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health