Provider Demographics
NPI:1831403948
Name:PEREZ, ORLANDO (R-LCSW & PSYD)
Entity type:Individual
Prefix:DR
First Name:ORLANDO
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:R-LCSW & PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2813
Mailing Address - Country:US
Mailing Address - Phone:631-727-2667
Mailing Address - Fax:631-772-1398
Practice Address - Street 1:400 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2813
Practice Address - Country:US
Practice Address - Phone:631-727-2667
Practice Address - Fax:631-772-1398
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR28598103TC0700X
NYR295981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical