Provider Demographics
NPI:1134617053
Name:PEREZ, ROSARY
Entity type:Individual
Prefix:
First Name:ROSARY
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 1:2908 19TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2518
Mailing Address - Country:US
Mailing Address - Phone:425-344-7080
Mailing Address - Fax:425-493-5801
Practice Address - Street 1:811 MADISON ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-4543
Practice Address - Country:US
Practice Address - Phone:425-212-4200
Practice Address - Fax:425-212-4201
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA101Y00000XMedicaid