Provider Demographics
NPI:1003448036
Name:PEREZ, KELLY ALLIN (MSW, PPSC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ALLIN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MSW, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 E 102ND ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-3338
Mailing Address - Country:US
Mailing Address - Phone:323-523-8600
Mailing Address - Fax:
Practice Address - Street 1:1522 E 102ND ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-3338
Practice Address - Country:US
Practice Address - Phone:323-523-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA934211041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical