Healthcare Provider Details

I. General information

NPI: 1437519980
Provider Name (Legal Business Name): MS. MARINELLY PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 06/30/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 JEROME AVE
BRONX NY
10467-1052
US

IV. Provider business mailing address

579 COURTLAND AVENUE
BRONX NY
10451
US

V. Phone/Fax

Practice location:
  • Phone: 718-881-7600
  • Fax:
Mailing address:
  • Phone: 718-485-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: