Provider Demographics
NPI:1316180631
Name:SANTANA PEREZ, MARLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARLEN
Middle Name:
Last Name:SANTANA 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:PO BOX 24730
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37202-4730
Mailing Address - Country:US
Mailing Address - Phone:615-386-2300
Mailing Address - Fax:615-386-2399
Practice Address - Street 1:4928 EDMONDSON PIKE
Practice Address - Street 2:SUITE 205
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4787
Practice Address - Country:US
Practice Address - Phone:615-222-1400
Practice Address - Fax:615-222-1410
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN50801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513193Medicaid
600577011OtherMAGELLAN
600577011OtherMAGELLAN
TN103I803723Medicare PIN