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General NPI Number Information
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NPI Number | 1316578107
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Entity Type | Individual
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Provider Name | AMANDA PEREZ MA
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Gender | Female
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Dates
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Enumeration Date | 01/30/2020
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Last Update Date | 01/30/2020
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Provider Practice Location Address
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Address Line | 130 AUSTINE DR
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City | BRATTLEBORO
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State | VT
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Zip | 05301-7040
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Country | US
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Telephone | 802-321-4412
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Fax |
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Provider Business Mailing Address
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Address Line | 26 BLACK LOCUST RD
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City | PUTNEY
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State | VT
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Zip | 05346-8880
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 097.0134147
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License Number State | VT
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