Basic Information
Provider Information
NPI: 1124333208
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PEREZ
FirstName: SARA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 444 N MAIN ST
Address2: ST. HOSPITAL - SUITE 420
City: AKRON
State: OH
PostalCode: 443103110
CountryCode: US
TelephoneNumber: 3303795094
FaxNumber: 3303795095
Practice Location
Address1: 444 N MAIN ST
Address2: ST. HOSPITAL - SUITE 420
City: AKRON
State: OH
PostalCode: 443103110
CountryCode: US
TelephoneNumber: 3303795094
FaxNumber: 3303795095
Other Information
ProviderEnumerationDate: 08/12/2010
LastUpdateDate: 08/12/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700X6681OHY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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