MEDICARE: TERESA PEREZ-MARTINEZ AMFT

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

General Provider Information

NPI Number	:	1922670611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA PEREZ-MARTINEZ AMFT

Provider Business Mailing Address
First Line	:	96 CORTE EULALIA
Second Line	:
City	:	SAN LORENZO
State	:	CA
Zip	:	94580-3402
Country	:	US
Telephone Number	:	510-589-8238
Fax Number	:

Provider Business Practice Location Address
First Line	:	1260 N DUTTON AVE STE 230
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-7161
Country	:	US
Telephone Number	:	707-525-1515
Fax Number	:

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

Provider Enumeration Date	:	07/13/2021
Last Update Date	:	07/13/2021

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