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General NPI Number Information
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NPI Number | 1053080895
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Entity Type | Individual
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Provider Name | SOPHIA MELISSA PEREZ MSW
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Gender | Female
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Dates
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Enumeration Date | 09/07/2021
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 6423 NW 30TH TER
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City | GAINESVILLE
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State | FL
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Zip | 32653-1426
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Country | US
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Telephone | 510-338-2180
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Fax |
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Provider Business Mailing Address
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Address Line | 6423 NW 30TH TER
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City | GAINESVILLE
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State | FL
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Zip | 32653-1426
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Country | US
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Telephone | 510-338-2180
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW16263
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License Number State |
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