MEDICARE: DR. KATHERINE PEREZ PHD

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	103T00000X	Psychologist	2502	NC

General Provider Information

NPI Number	:	1689650129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE PEREZ PHD

Provider Business Mailing Address
First Line	:	120 MEMORIAL DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6328
Country	:	US
Telephone Number	:	910-353-0581
Fax Number	:	910-353-1536

Provider Business Practice Location Address
First Line	:	120 MEMORIAL DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6328
Country	:	US
Telephone Number	:	910-353-0581
Fax Number	:	910-353-1536

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	07/08/2020

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