Provider Demographics
NPI:1902486459
Name:PEREZ, LEIDY LAURA
Entity Type:Individual
Prefix:
First Name:LEIDY
Middle Name:LAURA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1466 72ND ST # 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1712
Mailing Address - Country:US
Mailing Address - Phone:347-481-5196
Mailing Address - Fax:
Practice Address - Street 1:1466 72ND ST # 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1712
Practice Address - Country:US
Practice Address - Phone:347-481-5196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health