Provider Demographics
NPI:1760540520
Name:PEREZ, ANGELICA MARIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:MARIA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 ASHLAND ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2613
Mailing Address - Country:US
Mailing Address - Phone:917-817-2869
Mailing Address - Fax:646-219-8905
Practice Address - Street 1:99 MAIN ST
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-3109
Practice Address - Country:US
Practice Address - Phone:917-817-2869
Practice Address - Fax:646-219-8905
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014014-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02316127Medicaid
NYVL7232Medicare PIN
NY02316127Medicaid