MEDICARE: AMANDA C PERAZA LCSW 114253

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1154954840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA C PERAZA LCSW 114253

Provider Business Mailing Address
First Line	:	4170 ELM AVE UNIT 315
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-6912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4170 ELM AVE UNIT 315
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-6912
Country	:	US
Telephone Number	:	714-383-5327
Fax Number	:

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

Provider Enumeration Date	:	02/20/2020
Last Update Date	:	04/12/2023

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