Provider Demographics
NPI:1659440022
Name:PEREZ, PATRICIA WALSH (CNS)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:WALSH
Last Name:PEREZ
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:WALSH
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNS
Mailing Address - Street 1:PO BOX 2862
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2921
Mailing Address - Country:US
Mailing Address - Phone:631-751-6592
Mailing Address - Fax:631-689-5170
Practice Address - Street 1:249 ROUTE 25A
Practice Address - Street 2:SUITE 7
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2921
Practice Address - Country:US
Practice Address - Phone:631-751-6592
Practice Address - Fax:631-689-5170
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245166-01163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR08901Medicare ID - Type UnspecifiedCNS