Provider Demographics
NPI:1164832606
Name:PEREZ, OLGA I (LICSW)
Entity Type:Individual
Prefix:MS
First Name:OLGA
Middle Name:I
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 COMMONWEALTH AVE
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-2128
Mailing Address - Country:US
Mailing Address - Phone:617-407-1292
Mailing Address - Fax:
Practice Address - Street 1:328 COMMONWEALTH AVENUE
Practice Address - Street 2:APARTMENT 1
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-407-1292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1181211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical