Provider Demographics
NPI:1982482980
Name:PEREZ ALVAREZ, YELISSA
Entity Type:Individual
Prefix:
First Name:YELISSA
Middle Name:
Last Name:PEREZ ALVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HANCOCK BRIDGE PKWY APT 2
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-4014
Mailing Address - Country:US
Mailing Address - Phone:786-479-0726
Mailing Address - Fax:
Practice Address - Street 1:EXECUTIVE AND VIRTUAL OFFICE SUITES 18245 PAULSON DRIVE
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954
Practice Address - Country:US
Practice Address - Phone:813-528-7048
Practice Address - Fax:855-610-2343
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-293381106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician