Provider Demographics
NPI:1700415775
Name:PEREZ, KRISTINE MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MARIE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W CHESTER PIKE STE 205
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4540
Mailing Address - Country:US
Mailing Address - Phone:888-694-9996
Mailing Address - Fax:610-446-2722
Practice Address - Street 1:1100 POWELL ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3820
Practice Address - Country:US
Practice Address - Phone:610-279-9270
Practice Address - Fax:610-279-4146
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC0012239101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional