Provider Demographics
NPI:1912529603
Name:PEREIDA, ERIN THOMAS (MA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:THOMAS
Last Name:PEREIDA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 NEWBURY AVE APT 17
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2363
Mailing Address - Country:US
Mailing Address - Phone:661-747-8755
Mailing Address - Fax:
Practice Address - Street 1:75 FENWOOD RD FL 5
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6103
Practice Address - Country:US
Practice Address - Phone:617-754-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health