Provider Demographics
NPI:1811295405
Name:PEREZ, KRYSTLE GWENDOLYN (MA)
Entity type:Individual
Prefix:MRS
First Name:KRYSTLE
Middle Name:GWENDOLYN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 NORWEST DR
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-1485
Mailing Address - Country:US
Mailing Address - Phone:845-978-4761
Mailing Address - Fax:
Practice Address - Street 1:1613 BLUE HILL AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2123
Practice Address - Country:US
Practice Address - Phone:857-598-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor