Provider Demographics
NPI:1417408733
Name:PEREZ, VIRGINIA (LCSW, LICSW)
Entity Type:Individual
Prefix:MISS
First Name:VIRGINIA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 ANN ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-1613
Mailing Address - Country:US
Mailing Address - Phone:815-370-8975
Mailing Address - Fax:
Practice Address - Street 1:340 S THAMES CT
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1537
Practice Address - Country:US
Practice Address - Phone:815-370-8975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0186901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical