Provider Demographics
NPI:1558764555
Name:SUSAN MARIE PEREZ, LCSW, PLLC
Entity Type:Organization
Organization Name:SUSAN MARIE PEREZ, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:210-788-8111
Mailing Address - Street 1:138 E RIDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-2340
Mailing Address - Country:US
Mailing Address - Phone:210-788-8111
Mailing Address - Fax:210-822-0554
Practice Address - Street 1:138 E RIDGEWOOD CT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2340
Practice Address - Country:US
Practice Address - Phone:210-788-8111
Practice Address - Fax:210-822-0554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX576571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty