MEDICARE: ANA 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
1	104100000X	Social Worker	073910-1	NY
2	104100000X	Social Worker	58327	TX

General Provider Information

NPI Number	:	1669894416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA PEREZ LCSW

Provider Business Mailing Address
First Line	:	6633 ROSE ST
Second Line	:
City	:	FORT HOOD
State	:	TX
Zip	:	76544-1324
Country	:	US
Telephone Number	:	917-670-8010
Fax Number	:

Provider Business Practice Location Address
First Line	:	6633 ROSE ST
Second Line	:
City	:	FORT HOOD
State	:	TX
Zip	:	76544-1324
Country	:	US
Telephone Number	:	917-670-8010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2014
Last Update Date	:	01/14/2014

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