Provider Demographics
NPI:1629560222
Name:PEREZ, ALICE (PHD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:75 KINGS HIGHWAY CUTOFF FL 5
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5340
Mailing Address - Country:US
Mailing Address - Phone:475-261-8663
Mailing Address - Fax:
Practice Address - Street 1:75 KINGS HIGHWAY CUTOFF FL 5
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5340
Practice Address - Country:US
Practice Address - Phone:475-261-8663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1629560222103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist