Provider Information for 1104240688
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CLARISSA AMOR PERALTA LCSW
Sex: Female
NPI: 1104240688
Last Updated: 2021-04-08
Certification Date: 2021-04-08
Certification Date: 2021-04-08
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1104240688 | ||||||||
| Enumeration Date | 2014-02-05 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1700 WATERMAN ST DETROIT, MI 48209-2022 United States Phone: 915-613-7674 | Fax: | ||||||||
| Primary Practice Address | 1700 WATERMAN ST DETROIT, MI 48209-2022 United States Phone: 915-613-7674 | Fax: | ||||||||
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