Provider Demographics
NPI:1093032260
Name:PEREZ, CARLOS A (LMHC)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:A
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1533 S LIBERTY AVE
Mailing Address - Street 2:#K
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33034-2698
Mailing Address - Country:US
Mailing Address - Phone:305-323-5341
Mailing Address - Fax:305-246-9365
Practice Address - Street 1:654 NE 9TH PL
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4934
Practice Address - Country:US
Practice Address - Phone:305-248-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1091101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006677000Medicaid
FLMH1091OtherFLORIDA DEPARTMENT OF HEALTH