Provider Demographics
NPI:1538644133
Name:JENNIFER PERES LCSW LLC
Entity Type:Organization
Organization Name:JENNIFER PERES LCSW LLC
Other - Org Name:JENNIFER PERES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PERES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-699-1855
Mailing Address - Street 1:7609 GUADALUPE TRL NW
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6503
Mailing Address - Country:US
Mailing Address - Phone:505-699-1855
Mailing Address - Fax:
Practice Address - Street 1:300 PASEO DE PERALTA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-5501
Practice Address - Country:US
Practice Address - Phone:505-699-1855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health