Provider Demographics
NPI:1598945842
Name:PEREZ, SUSAN MARIE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:MOHLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5555 FREDERICKSBURG RD
Mailing Address - Street 2:102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3500
Mailing Address - Country:US
Mailing Address - Phone:210-616-0828
Mailing Address - Fax:
Practice Address - Street 1:5555 FREDERICKSBURG RD
Practice Address - Street 2:102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3500
Practice Address - Country:US
Practice Address - Phone:210-616-0828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-04
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX576571041C0700X
CA223021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical