Individual
JEANNINE DIANE PEREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
171 FOREST ST, OCEANSIDE, NY 11572-4208
(516) 665-2163
Mailing address
171 FOREST ST, OCEANSIDE, NY 11572-4208
(516) 665-2163
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
002597
NY
252Y00000X
Early Intervention Provider Agency
808530
NY
Other
Enumeration date
03/19/2015
Last updated
06/07/2024
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