Provider Demographics
NPI:1568675809
Name:PEREZ, OMAYRA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:OMAYRA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 FRANKLIN AVE
Mailing Address - Street 2:SUITE LL-8
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4827
Mailing Address - Country:US
Mailing Address - Phone:516-448-2101
Mailing Address - Fax:
Practice Address - Street 1:1527 FRANKLIN AVE
Practice Address - Street 2:SUITE LL-8
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4827
Practice Address - Country:US
Practice Address - Phone:516-448-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069320-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY069320-1OtherLCSW