Provider Demographics
NPI:1912203571
Name:PEREZ, SUSSI F (MS,MED LMHC)
Entity Type:Individual
Prefix:MS
First Name:SUSSI
Middle Name:F
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MS,MED LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1894 SE LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5850
Mailing Address - Country:US
Mailing Address - Phone:401-862-7292
Mailing Address - Fax:
Practice Address - Street 1:3307 NORTHLAKE BLVD STE B104
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1703
Practice Address - Country:US
Practice Address - Phone:401-862-7292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00499101YM0800X
FLMH13781101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health