Provider Demographics
NPI:1215000674
Name:PEREA, BRENDA L (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:L
Last Name:PEREA
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 S BAYFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-2798
Mailing Address - Country:US
Mailing Address - Phone:719-544-0877
Mailing Address - Fax:719-544-2033
Practice Address - Street 1:417 W 13TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2703
Practice Address - Country:US
Practice Address - Phone:719-544-0877
Practice Address - Fax:719-544-2033
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9927521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical