MEDICARE: MICHELE ANNETTE PEREZ

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1972059640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE ANNETTE PEREZ

Provider Business Mailing Address
First Line	:	1369 65TH ST
Second Line	:	APT 1A
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5618
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1369 65TH ST
Second Line	:	1A
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5618
Country	:	US
Telephone Number	:	347-291-5897
Fax Number	:

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

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	08/31/2016

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Directions to “ MICHELE ANNETTE PEREZ ” Practice Location

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