Provider Demographics
NPI:1407963861
Name:PEREYRA, MARTA J (LCPC)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:J
Last Name:PEREYRA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5344 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1250
Mailing Address - Country:US
Mailing Address - Phone:773-774-1980
Mailing Address - Fax:773-775-1865
Practice Address - Street 1:5344 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1250
Practice Address - Country:US
Practice Address - Phone:773-774-1980
Practice Address - Fax:773-775-1865
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health