Healthcare Provider Details

I. General information

NPI: 1831403948
Provider Name (Legal Business Name): ORLANDO PEREZ R-LCSW & PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 CLUBHOUSE DR
PATCHOGUE NY
11772-8202
US

IV. Provider business mailing address

122 CLUBHOUSE DR
PATCHOGUE NY
11772-8202
US

V. Phone/Fax

Practice location:
  • Phone: 631-605-3580
  • Fax:
Mailing address:
  • Phone: 631-605-3580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29598
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number29598
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: