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General NPI Number Information
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NPI Number | 1538662432
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Entity Type | Organization
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Legal Business Name | MV PERERA LICENSED CLINICAL SOCIAL WORKER, INC.
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 03/16/2018
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Provider Practice Location Address
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Address Line | 3332 HEIGHTS DR STE 235
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City | CAMERON PARK
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State | CA
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Zip | 95682-7774
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Country | US
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Telephone | 916-947-5279
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Fax | 530-852-0944
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Provider Business Mailing Address
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Address Line | 8475 BLUE MAIDEN CT
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City | ELK GROVE
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State | CA
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Zip | 95624-3897
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Country | US
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Telephone | 916-947-5279
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Fax | 530-852-0944
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Authorized Official
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Title or Position | CEO
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Name | MANOJ V PERERA
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Credential | LCSW
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Telephone | 916-947-5279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 24260
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License Number State | CA
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