Healthcare Provider Details

I. General information

NPI: 1407013055
Provider Name (Legal Business Name): LADY J PEREZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 E. 110TH STREET
NEW YORK NY
10029-6574
US

IV. Provider business mailing address

112 COLUMBIA AVE
BERGENFIELD NJ
07621-1211
US

V. Phone/Fax

Practice location:
  • Phone: 212-426-3400
  • Fax:
Mailing address:
  • Phone: 917-309-7590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081757
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: