Provider Demographics
NPI:1598823429
Name:PEREIRA, JOSEPH R (MSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:R
Last Name:PEREIRA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-6535
Mailing Address - Country:US
Mailing Address - Phone:781-643-5251
Mailing Address - Fax:781-648-0718
Practice Address - Street 1:94 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476
Practice Address - Country:US
Practice Address - Phone:781-643-5251
Practice Address - Fax:781-648-0718
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10179781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP06235Medicare ID - Type Unspecified