Provider Demographics
NPI:1790033462
Name:PEREZ, CECILIA DEL CARMEN (SLP)
Entity Type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:DEL CARMEN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BROADHOLLOW RD STE 402
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4899
Mailing Address - Country:US
Mailing Address - Phone:631-385-7780
Mailing Address - Fax:646-839-5781
Practice Address - Street 1:8135 PAINTER AVE STE 200
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-3168
Practice Address - Country:US
Practice Address - Phone:631-385-7780
Practice Address - Fax:646-839-5781
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7741235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist