Provider Demographics
NPI:1598289829
Name:PEREZ, LILLIAN (LCSW)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LILLIAN
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:13542 N FLORIDA AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3263
Mailing Address - Country:US
Mailing Address - Phone:813-538-9234
Mailing Address - Fax:813-442-7151
Practice Address - Street 1:13542 N FLORIDA AVENUE
Practice Address - Street 2:SUITE 210
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613
Practice Address - Country:US
Practice Address - Phone:813-538-9234
Practice Address - Fax:813-442-7151
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLSW146221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker