Healthcare Provider Details

I. General information

NPI: 1568919587
Provider Name (Legal Business Name): JENNIFER PEREZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10474 MATHER BLVD
MATHER CA
95655-4116
US

IV. Provider business mailing address

10474 MATHER BLVD
MATHER CA
95655-4116
US

V. Phone/Fax

Practice location:
  • Phone: 916-224-7507
  • Fax:
Mailing address:
  • Phone: 916-224-7507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number88315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: