MEDICARE: MARIA JOSEFA PEREZ M.S., ED.

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
1	101YM0800X	Mental Health Counselor	MH 8782	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679663553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA JOSEFA PEREZ M.S., ED.

Provider Business Mailing Address
First Line	:	3900 BROADWAY
Second Line	:	SUITE B-1
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8193
Country	:	US
Telephone Number	:	239-939-2808
Fax Number	:	239-939-4794

Provider Business Practice Location Address
First Line	:	3900 BROADWAY
Second Line	:	SUITE B-1
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8193
Country	:	US
Telephone Number	:	239-939-2808
Fax Number	:	239-939-4794

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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