Provider Demographics
NPI:1669590915
Name:PERETZ, CONSTANCE (PHD)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:
Last Name:PERETZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8018 235TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2120
Mailing Address - Country:US
Mailing Address - Phone:718-776-3899
Mailing Address - Fax:
Practice Address - Street 1:8018 235TH ST
Practice Address - Street 2:
Practice Address - City:BELLEROSE MANOR
Practice Address - State:NY
Practice Address - Zip Code:11427-2120
Practice Address - Country:US
Practice Address - Phone:718-776-3899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015376103TC0700X, 103TF0000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist