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General NPI Number Information
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NPI Number | 1801021035
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Entity Type | Individual
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Provider Name | JEFFREY MICHAEL PEREZ LCSW
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Gender | Male
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Dates
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Enumeration Date | 05/18/2009
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 11139 FOST LANE
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City | HAMMOND
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State | LA
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Zip | 70403
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Country | US
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Telephone | 225-294-0401
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Fax |
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Provider Business Mailing Address
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Address Line | 347 WILLOW BND
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City | YOUNGSVILLE
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State | LA
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Zip | 70592-5136
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Country | US
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Telephone | 337-856-0600
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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 | 1787
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License Number State | LA
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