Healthcare Provider Details

I. General information

NPI: 1528117769
Provider Name (Legal Business Name): EDUARDO V PEREIRA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S WASHINGTON ST SUITE 200
MARION IN
46952-3867
US

IV. Provider business mailing address

1814 W 500 N
MARION IN
46952-9107
US

V. Phone/Fax

Practice location:
  • Phone: 765-662-9971
  • Fax: 765-651-6566
Mailing address:
  • Phone: 765-664-7364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34001263A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: