Provider Demographics
NPI:1194261693
Name:PEREZ, KELLY (MS LBS BCBA)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MS LBS BCBA
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:RICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:213 N STERLING ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5140
Mailing Address - Country:US
Mailing Address - Phone:610-442-8583
Mailing Address - Fax:
Practice Address - Street 1:807 LAWN AVE
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1549
Practice Address - Country:US
Practice Address - Phone:267-404-5988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003213103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst