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General NPI Number Information
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NPI Number | 1861791576
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Entity Type | Organization
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Legal Business Name | GLORIA PEREZ2
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Dates
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Enumeration Date | 03/21/2011
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Last Update Date | 03/21/2011
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Provider Practice Location Address
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Address Line | 330 HAVEN AVE APT. 5-M
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City | NEW YORK
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State | NY
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Zip | 10033-5300
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Country | US
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Telephone | 917-853-5243
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Fax | 121-279-5256
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Provider Business Mailing Address
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Address Line | 330 HAVEN AVE APT. 5-M
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City | NEW YORK
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State | NY
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Zip | 10033-5300
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Country | US
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Telephone | 917-853-5243
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Fax | 121-279-5256
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Authorized Official
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Title or Position | BEHAVIOR ANALYST
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Name | MS. GLORIA MARIA PEREZ
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Credential | ED.MS
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Telephone | 917-853-5243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 52100
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License Number State | NY
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