Provider Demographics
NPI:1174822365
Name:PEREZ, CECILIA R (MS LMFT)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:R
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BODEGA AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2672
Mailing Address - Country:US
Mailing Address - Phone:707-490-2115
Mailing Address - Fax:707-782-0102
Practice Address - Street 1:1 BODEGA AVE STE 2
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2672
Practice Address - Country:US
Practice Address - Phone:707-490-2115
Practice Address - Fax:707-782-0102
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80322106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist