Provider Demographics
NPI:1891336996
Name:PEREIRA, AMY GRACE (BA)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:GRACE
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-2915
Mailing Address - Country:US
Mailing Address - Phone:508-345-5642
Mailing Address - Fax:
Practice Address - Street 1:460 FOREST ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-2915
Practice Address - Country:US
Practice Address - Phone:508-345-5642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health