Provider Demographics
NPI:1477207322
Name:PEREZ, BERENICE
Entity Type:Individual
Prefix:
First Name:BERENICE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6N897 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-6662
Mailing Address - Country:US
Mailing Address - Phone:847-385-8022
Mailing Address - Fax:
Practice Address - Street 1:6N897 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-6662
Practice Address - Country:US
Practice Address - Phone:847-385-8022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical