Healthcare Provider Details

I. General information

NPI: 1235404351
Provider Name (Legal Business Name): MOLLY IRENE PEREZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 32ND ST SW
WYOMING MI
49509-2806
US

IV. Provider business mailing address

1048 32ND ST SW
WYOMING MI
49509-2806
US

V. Phone/Fax

Practice location:
  • Phone: 616-902-0728
  • Fax:
Mailing address:
  • Phone: 616-293-6876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801086154
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801086154
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: