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NPI Code Detail

MEDICARE: JULIETA P PEREZ LCSW

MEDICARE: JULIETA P PEREZ LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
3261QM0850XAdult Mental Health Clinic/Center
4261QM0855XAdolescent and Children Mental Health Clinic/Center
51041C0700XClinical Social Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1149.016540OTHERILLICENSE CLINICAL SOCIAL WORKER

General Provider Information

NPI Number : 1588958128
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIETA P PEREZ LCSW
Provider Business Mailing Address
First Line : 2923 N MILWAUKEE AVE STE 302
Second Line :
City : CHICAGO
State : IL
Zip : 60618-7886
Country : US
Telephone Number : 800-206-8136
Fax Number : 708-575-3167
Provider Business Practice Location Address
First Line : 2923 N MILWAUKEE AVE STE 302
Second Line :
City : CHICAGO
State : IL
Zip : 60618-7886
Country : US
Telephone Number : 773-567-9763
Fax Number : 312-873-4749
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2011
Last Update Date : 07/15/2022

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Directions to “ JULIETA P PEREZ LCSW” Practice Location

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