Healthcare Provider Details

I. General information

NPI: 1063931095
Provider Name (Legal Business Name): JESSICA D PEREIRA LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 VILLAGE DR STE 101
SAN ANTONIO TX
78217-5510
US

IV. Provider business mailing address

2250 CHAPEL AVE W STE 120
CHERRY HILL NJ
08002-2051
US

V. Phone/Fax

Practice location:
  • Phone: 726-201-3047
  • Fax:
Mailing address:
  • Phone: 201-792-8290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number107670
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06275300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: