Provider Demographics
NPI:1942624283
Name:PERUSEK, MARIA (EDS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:PERUSEK
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 CENTER ST
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1098
Mailing Address - Country:US
Mailing Address - Phone:440-279-1708
Mailing Address - Fax:440-286-7106
Practice Address - Street 1:470 CENTER ST
Practice Address - Street 2:BUILDING 2
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1098
Practice Address - Country:US
Practice Address - Phone:440-279-1708
Practice Address - Fax:440-286-7106
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool