Provider Demographics
NPI:1811440787
Name:PEREZ, AMANDA ROSE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ROSE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:ROSE
Other - Last Name:TOCCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:25400 US HIGHWAY 19 N STE 156
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-2150
Mailing Address - Country:US
Mailing Address - Phone:727-265-1147
Mailing Address - Fax:
Practice Address - Street 1:25400 US HIGHWAY 19 N STE 156
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-2150
Practice Address - Country:US
Practice Address - Phone:727-265-1147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT2124106H00000X
FLMT3732106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist