MEDICARE: DR. ANGELICA MARIA PEREZ PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	014014-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760540520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELICA MARIA PEREZ PHD

Provider Business Mailing Address
First Line	:	908 ASHLAND ST
Second Line	:
City	:	VALLEY COTTAGE
State	:	NY
Zip	:	10989-2613
Country	:	US
Telephone Number	:	917-817-2869
Fax Number	:	646-219-8905

Provider Business Practice Location Address
First Line	:	99 MAIN ST
Second Line	:
City	:	NYACK
State	:	NY
Zip	:	10960-3109
Country	:	US
Telephone Number	:	917-817-2869
Fax Number	:	646-219-8905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	09/10/2008

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