Provider Demographics
NPI:1710476304
Name:PEREZ, WILLIAM R
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:PEREZ
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:PO BOX 521
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01842-1121
Mailing Address - Country:US
Mailing Address - Phone:978-390-2324
Mailing Address - Fax:
Practice Address - Street 1:137 ARLINGTON ST APT B
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-1647
Practice Address - Country:US
Practice Address - Phone:978-390-2324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8177894736201OtherWELLFORCE CARE PLAN
MA100028661609OtherMASS HEALTH