Provider Demographics
NPI:1194210211
Name:PEREA, IDA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:IDA
Middle Name:ANN
Last Name:PEREA
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 1:1247 ALLAIRE LOOP
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-2378
Mailing Address - Country:US
Mailing Address - Phone:434-962-0181
Mailing Address - Fax:
Practice Address - Street 1:1247 ALLAIRE LOOP
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2378
Practice Address - Country:US
Practice Address - Phone:434-962-0181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-30
Last Update Date:2018-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW121881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical