Provider Demographics
NPI:1740448455
Name:PEREZ, GRACIELA (LMHC)
Entity type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3690 MIRAMONTES CIR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8825
Mailing Address - Country:US
Mailing Address - Phone:561-358-9414
Mailing Address - Fax:561-798-9547
Practice Address - Street 1:12230 W FOREST HILL BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-5700
Practice Address - Country:US
Practice Address - Phone:561-358-9414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9077101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ150BOtherBCBS