Provider Demographics
NPI:1588245948
Name:PERSEVERANCE BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:PERSEVERANCE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SHANISE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:508-266-0999
Mailing Address - Street 1:415 BOSTON TPKE STE 308A
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3446
Mailing Address - Country:US
Mailing Address - Phone:508-266-0999
Mailing Address - Fax:774-374-8067
Practice Address - Street 1:45 LYMAN ST STE 25
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-2658
Practice Address - Country:US
Practice Address - Phone:508-266-0999
Practice Address - Fax:774-374-8067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-17
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)