Healthcare Provider Details

I. General information

NPI: 1184157067
Provider Name (Legal Business Name): VICTORIA LORENA PEREZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S PINE ISLAND RD # 300
PLANTATION FL
33324-2669
US

IV. Provider business mailing address

9606 NW 26TH PL
SUNRISE FL
33322-2741
US

V. Phone/Fax

Practice location:
  • Phone: 954-607-0264
  • Fax:
Mailing address:
  • Phone: 954-607-0264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW14379
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14379
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: