Provider Demographics
NPI:1083347363
Name:PERALEZ, MARY-KATHERINE LOUETTA (LPC, LMHC, LCPC)
Entity type:Individual
Prefix:
First Name:MARY-KATHERINE
Middle Name:LOUETTA
Last Name:PERALEZ
Suffix:
Gender:F
Credentials:LPC, LMHC, LCPC
Other - Prefix:
Other - First Name:MARY-KATHERINE
Other - Middle Name:LOUETTA
Other - Last Name:ACHOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LPC-ASSOCIATE
Mailing Address - Street 1:519 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:519 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1526
Practice Address - Country:US
Practice Address - Phone:860-471-7896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI01705101YM0800X
KS03756101YP2500X
CT5530101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health