Provider Demographics
NPI:1568107712
Name:PEREZ, LETICIA (MA)
Entity Type:Individual
Prefix:MS
First Name:LETICIA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 W AINSLIE ST APT D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-6178
Mailing Address - Country:US
Mailing Address - Phone:773-672-9404
Mailing Address - Fax:
Practice Address - Street 1:30 N MICHIGAN AVE STE 809
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3776
Practice Address - Country:US
Practice Address - Phone:312-767-2057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional