Healthcare Provider Details

I. General information

NPI: 1104581016
Provider Name (Legal Business Name): MARIA VICTORIA PEREZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 NEW BRITAIN AVE
WEST HARTFORD CT
06110-2440
US

IV. Provider business mailing address

1125 NEW BRITAIN AVE
WEST HARTFORD CT
06110-2440
US

V. Phone/Fax

Practice location:
  • Phone: 929-322-4708
  • Fax:
Mailing address:
  • Phone: 929-322-4708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16051
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: