Provider Demographics
NPI:1346829199
Name:PEREZ, KEISHARELY (MS, LCPC)
Entity type:Individual
Prefix:
First Name:KEISHARELY
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 GUILFORD AVE
Mailing Address - Street 2:PMB 3085
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4490
Mailing Address - Country:US
Mailing Address - Phone:787-414-7177
Mailing Address - Fax:681-310-0710
Practice Address - Street 1:822 GUILFORD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3707
Practice Address - Country:US
Practice Address - Phone:787-414-7177
Practice Address - Fax:681-310-0710
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC13372101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health