Provider Demographics
NPI:1114350279
Name:PEREZ, LAILA SIDDIQUE (LCSW)
Entity Type:Individual
Prefix:
First Name:LAILA
Middle Name:SIDDIQUE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 MASSACHUSETTS AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3750
Mailing Address - Country:US
Mailing Address - Phone:978-735-5270
Mailing Address - Fax:
Practice Address - Street 1:360 MASSACHUSETTS AVE STE 201
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720
Practice Address - Country:US
Practice Address - Phone:978-735-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical