Provider Demographics
NPI:1720254154
Name:PEREZ-CABELLO, LISA-RENEE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LISA-RENEE
Middle Name:
Last Name:PEREZ-CABELLO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 CARLETON ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-2702
Mailing Address - Country:US
Mailing Address - Phone:203-865-0110
Mailing Address - Fax:203-865-0110
Practice Address - Street 1:31 CHERRY ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3465
Practice Address - Country:US
Practice Address - Phone:203-464-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001105106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001105OtherSTATE LICENSE NUMBER