Provider Demographics
NPI:1063961613
Name:PEREZ, PATRICIA CARLA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:CARLA
Last Name:PEREZ
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 1:513 QUINTARD LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-2512
Mailing Address - Country:US
Mailing Address - Phone:203-296-0838
Mailing Address - Fax:
Practice Address - Street 1:2400 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606
Practice Address - Country:US
Practice Address - Phone:203-362-3900
Practice Address - Fax:203-362-3919
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT94681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical