Provider Demographics
NPI:1619072170
Name:PEREZ, MARIA ELENA (PHD)
Entity Type:Individual
Prefix:MS
First Name:MARIA ELENA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARIA ELENA
Other - Middle Name:
Other - Last Name:PAGELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W286S4785 WOODS RD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-9051
Mailing Address - Country:US
Mailing Address - Phone:262-894-2658
Mailing Address - Fax:
Practice Address - Street 1:1045 W GLEN OAKS LN STE 205
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3467
Practice Address - Country:US
Practice Address - Phone:262-894-2658
Practice Address - Fax:262-378-3202
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2932-57103T00000X, 103TC0700X
WI38161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39714800Medicaid
WI01545Medicare PIN
WI521805Medicare Oscar/Certification