Provider Demographics
NPI:1487990123
Name:PEREZ, JENNIFER (MSW, BCBA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 PARK ST
Mailing Address - Street 2:SUITE 2023
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3434
Mailing Address - Country:US
Mailing Address - Phone:844-823-7865
Mailing Address - Fax:973-783-4407
Practice Address - Street 1:26 PARK ST
Practice Address - Street 2:SUITE 2023
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3434
Practice Address - Country:US
Practice Address - Phone:844-823-7865
Practice Address - Fax:973-783-4407
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-8170103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst