Provider Demographics
NPI:1366027245
Name:PERDOMO, EMILIO (LCSW)
Entity Type:Individual
Prefix:
First Name:EMILIO
Middle Name:
Last Name:PERDOMO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3478 BUSKIRK AVE STE 1000
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4378
Mailing Address - Country:US
Mailing Address - Phone:925-289-8788
Mailing Address - Fax:
Practice Address - Street 1:3478 BUSKIRK AVE STE 1000
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4378
Practice Address - Country:US
Practice Address - Phone:925-289-8788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1082351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1144396979Medicaid