Provider Demographics
NPI:1568889293
Name:PEREZ, RAFAEL (LCSWR)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 KRISNAN PL
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-4312
Mailing Address - Country:US
Mailing Address - Phone:845-596-2764
Mailing Address - Fax:
Practice Address - Street 1:304 WALL ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3850
Practice Address - Country:US
Practice Address - Phone:845-596-2764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0802131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical