Provider Demographics
NPI:1013501345
Name:PEREIRA, DULCE MAZONI COSTA
Entity Type:Individual
Prefix:
First Name:DULCE
Middle Name:MAZONI COSTA
Last Name:PEREIRA
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 1:7009 62ND DR APT 2
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1208
Mailing Address - Country:US
Mailing Address - Phone:347-293-3979
Mailing Address - Fax:
Practice Address - Street 1:7009 62ND DR APT 2
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1208
Practice Address - Country:US
Practice Address - Phone:347-293-3979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician