Provider Demographics
NPI:1316298680
Name:PEREZ HERNANDEZ, INGRID D (MS)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:D
Last Name:PEREZ HERNANDEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 HARLEY DR
Mailing Address - Street 2:APARTMENT 5
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-1771
Mailing Address - Country:US
Mailing Address - Phone:939-640-7979
Mailing Address - Fax:
Practice Address - Street 1:46 HARLEY DR
Practice Address - Street 2:APARTMENT 5
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-1771
Practice Address - Country:US
Practice Address - Phone:939-640-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health