Provider Demographics
NPI:1457822306
Name:PEREZ, KARLA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KARLA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10917 132ND ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-1708
Mailing Address - Country:US
Mailing Address - Phone:718-264-4672
Mailing Address - Fax:
Practice Address - Street 1:NEW YORK CITY CHILDREN'S CENTER OMH
Practice Address - Street 2:74-03 COMMONWEALTH BLVD.
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11420-1142
Practice Address - Country:US
Practice Address - Phone:718-264-4672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082856-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY082856-1OtherLICENSE LMSW