Provider Demographics
NPI:1679044853
Name:PEREZ-BLANCHIROT, JOSE LORENZO
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LORENZO
Last Name:PEREZ-BLANCHIROT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 PARK ST STE 3
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-8048
Mailing Address - Country:US
Mailing Address - Phone:508-272-4310
Mailing Address - Fax:508-223-4145
Practice Address - Street 1:140 PARK ST STE 3
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-8048
Practice Address - Country:US
Practice Address - Phone:508-272-4310
Practice Address - Fax:508-223-4145
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool