Provider Demographics
NPI:1427107507
Name:PEREZ, PEDRO (LMHC)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18311 HILLSIDE AVE
Mailing Address - Street 2:5M
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4840
Mailing Address - Country:US
Mailing Address - Phone:718-523-1170
Mailing Address - Fax:
Practice Address - Street 1:18311 HILLSIDE AVE
Practice Address - Street 2:5M
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4840
Practice Address - Country:US
Practice Address - Phone:718-523-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002097-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health