Provider Demographics
NPI:1386654085
Name:PEREZ, TONI A (LCSW)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:A
Last Name: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 1:1585 MILITARY TPKE
Mailing Address - Street 2:PO BOX 455
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-7457
Mailing Address - Country:US
Mailing Address - Phone:518-561-0100
Mailing Address - Fax:518-561-5624
Practice Address - Street 1:1585 MILITARY TPKE
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-7457
Practice Address - Country:US
Practice Address - Phone:518-561-0100
Practice Address - Fax:518-561-5624
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06590011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical