Healthcare Provider Details

I. General information

NPI: 1982253464
Provider Name (Legal Business Name): KATIA MICHELLE PEREZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2019
Last Update Date: 09/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4490 AVE CONSTANCIA
PONCE PR
00716-2208
US

IV. Provider business mailing address

4490 AVE CONSTANCIA
PONCE PR
00716-2208
US

V. Phone/Fax

Practice location:
  • Phone: 787-617-1273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10763
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: