Provider Demographics
NPI:1013082999
Name:PERESKE, DORIS BELLE (ACSW)
Entity Type:Individual
Prefix:MS
First Name:DORIS
Middle Name:BELLE
Last Name:PERESKE
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4511
Mailing Address - Country:US
Mailing Address - Phone:607-222-5362
Mailing Address - Fax:607-772-2091
Practice Address - Street 1:46 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4511
Practice Address - Country:US
Practice Address - Phone:607-222-5362
Practice Address - Fax:607-772-2091
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-23
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-031182-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54587BMedicare ID - Type Unspecified