Healthcare Provider Details

I. General information

NPI: 1306779764
Provider Name (Legal Business Name): MADELINE PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 SOUTH ST STE 2W
PITTSFIELD MA
01201-8243
US

IV. Provider business mailing address

877 SOUTH ST STE 2W
PITTSFIELD MA
01201-8243
US

V. Phone/Fax

Practice location:
  • Phone: 413-236-5656
  • Fax: 413-774-1197
Mailing address:
  • Phone: 413-236-5656
  • Fax: 413-774-1197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number893019
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN10048615
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN10048615
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF408910-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: