Provider Demographics
NPI:1649959859
Name:PEREZ, REBEKAH LEIGH (LMSW)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LEIGH
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67B ALLEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:CT
Mailing Address - Zip Code:06234-1801
Mailing Address - Country:US
Mailing Address - Phone:860-420-9259
Mailing Address - Fax:
Practice Address - Street 1:67B ALLEN HILL RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:CT
Practice Address - Zip Code:06234-1801
Practice Address - Country:US
Practice Address - Phone:860-420-9259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7759104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker