Provider Demographics
NPI:1326578030
Name:PEREZ, JUAN ALBERTO
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:ALBERTO
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3326 WHITE PLAINS RD APT 4F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-5759
Mailing Address - Country:US
Mailing Address - Phone:646-966-0447
Mailing Address - Fax:
Practice Address - Street 1:3326 WHITE PLAINS RD APT 4F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-5759
Practice Address - Country:US
Practice Address - Phone:646-966-0447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVP16986MMedicaid