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NPI Code Detail

MEDICARE: MS. MARISOL PEREZ LMSW

MEDICARE: MS. MARISOL PEREZ LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1619115862
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARISOL PEREZ LMSW
Provider Business Mailing Address
First Line : 31 E SEAMAN AVE
Second Line :
City : FREEPORT
State : NY
Zip : 11520-1614
Country : US
Telephone Number : 516-964-6494
Fax Number :
Provider Business Practice Location Address
First Line : 344 FULTON AVE
Second Line :
City : HEMPSTEAD
State : NY
Zip : 11550-3923
Country : US
Telephone Number : 516-538-2613
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2009
Last Update Date : 03/29/2011

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