MEDICARE: MS. JOSEFA PEREA LISW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	I-3048	NM
2	1041C0700X	Clinical Social Worker	I-3048	NM

General Provider Information

NPI Number	:	1043533789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOSEFA PEREA LISW

Provider Business Mailing Address
First Line	:	742 STAGECOACH DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8034
Country	:	US
Telephone Number	:	575-571-9980
Fax Number	:	575-522-8907

Provider Business Practice Location Address
First Line	:	742 STAGECOACH DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8034
Country	:	US
Telephone Number	:	575-571-9980
Fax Number	:	575-522-8907

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	03/09/2010

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