Healthcare Provider Details

I. General information

NPI: 1689306805
Provider Name (Legal Business Name): ADRIANA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/27/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 JAMAICA AVE
MEDFORD NY
11763-3252
US

IV. Provider business mailing address

322 JAMAICA AVE
MEDFORD NY
11763-3252
US

V. Phone/Fax

Practice location:
  • Phone: 347-335-2824
  • Fax:
Mailing address:
  • Phone: 347-335-2824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: