Provider Demographics
NPI:1124553201
Name:PEREZ, LOURDES (IMFT)
Entity Type:Individual
Prefix:MS
First Name:LOURDES
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7875 SW 104TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2677
Mailing Address - Country:US
Mailing Address - Phone:305-401-1890
Mailing Address - Fax:
Practice Address - Street 1:7875 SW 104TH ST
Practice Address - Street 2:STE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2677
Practice Address - Country:US
Practice Address - Phone:305-401-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist