Provider Demographics
NPI:1083311013
Name:SAMBOY PEREZ, OSVALDO JOEL
Entity Type:Individual
Prefix:
First Name:OSVALDO
Middle Name:JOEL
Last Name:SAMBOY PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:PA
Mailing Address - Zip Code:19560-1643
Mailing Address - Country:US
Mailing Address - Phone:610-741-4198
Mailing Address - Fax:
Practice Address - Street 1:3803 KUTZTOWN RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-1844
Practice Address - Country:US
Practice Address - Phone:610-507-1977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1041S0200X
PASW136294104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool