Provider Demographics
NPI:1851696793
Name:PEREZ, MARTHA ISABEL (BCABA)
Entity Type:Individual
Prefix:MISS
First Name:MARTHA
Middle Name:ISABEL
Last Name:PEREZ
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CLAUDETTE DR
Mailing Address - Street 2:APT 10
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1464
Mailing Address - Country:US
Mailing Address - Phone:305-281-0409
Mailing Address - Fax:
Practice Address - Street 1:23 MIDSTATE DR
Practice Address - Street 2:SUITE 214
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-1857
Practice Address - Country:US
Practice Address - Phone:774-243-1179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0-13-5428103K00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst