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General NPI Number Information
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NPI Number | 1558764555
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Entity Type | Organization
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Legal Business Name | SUSAN MARIE PEREZ, LCSW, PLLC
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Dates
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Enumeration Date | 10/03/2014
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Last Update Date | 10/03/2014
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Provider Practice Location Address
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Address Line | 138 E RIDGEWOOD CT
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City | SAN ANTONIO
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State | TX
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Zip | 78212-2340
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Country | US
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Telephone | 210-788-8111
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Fax | 210-822-0554
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Provider Business Mailing Address
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Address Line | 138 E RIDGEWOOD CT
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City | SAN ANTONIO
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State | TX
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Zip | 78212-2340
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Country | US
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Telephone | 210-788-8111
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Fax | 210-822-0554
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | SUSAN MARIE PEREZ
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Credential | LCSW
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Telephone | 210-788-8111
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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 | 57657
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License Number State | TX
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