Healthcare Provider Details

I. General information

NPI: 1396923876
Provider Name (Legal Business Name): JOSEPH PERALES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 BROADWAY
NEWBURGH NY
12550-6204
US

IV. Provider business mailing address

30 HARRIMAN DR
GOSHEN NY
10924
US

V. Phone/Fax

Practice location:
  • Phone: 845-568-5260
  • Fax: 845-568-5213
Mailing address:
  • Phone: 845-291-2143
  • Fax: 845-291-4145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR072103
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: