Provider Demographics
NPI:1326630294
Name:PEREZ, SANDRA I (SOCIAL WORKER)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:I
Last Name:PEREZ
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14875 NW 77TH AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014
Mailing Address - Country:US
Mailing Address - Phone:305-351-7086
Mailing Address - Fax:350-824-0665
Practice Address - Street 1:14875 NW 77TH AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014
Practice Address - Country:US
Practice Address - Phone:305-351-7086
Practice Address - Fax:350-824-0665
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSW10911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical