Provider Demographics
NPI:1942797865
Name:PEREZ, ROSA ALBA
Entity Type:Individual
Prefix:
First Name:ROSA ALBA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 POMPERAUG RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-3713
Mailing Address - Country:US
Mailing Address - Phone:203-313-5537
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:58 POMPERAUG RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3713
Practice Address - Country:US
Practice Address - Phone:203-313-5537
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1797103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst