Provider Demographics
NPI:1003157389
Name:PEREZ, JAVIER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 MEADE AVE
Mailing Address - Street 2:3
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4113
Mailing Address - Country:US
Mailing Address - Phone:619-787-2534
Mailing Address - Fax:
Practice Address - Street 1:2305 MEADE AVE
Practice Address - Street 2:3
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4113
Practice Address - Country:US
Practice Address - Phone:619-787-2534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical