Provider Demographics
NPI:1922670611
Name:PEREZ-MARTINEZ, TERESA (AMFT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:PEREZ-MARTINEZ
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 CORTE EULALIA
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580-3402
Mailing Address - Country:US
Mailing Address - Phone:510-589-8238
Mailing Address - Fax:
Practice Address - Street 1:1260 N DUTTON AVE STE 230
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-7161
Practice Address - Country:US
Practice Address - Phone:707-525-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health