Provider Demographics
NPI:1619203601
Name:PEREZ, JULIANA AVILA (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:AVILA
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 1:1731 N COMAL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4214
Mailing Address - Country:US
Mailing Address - Phone:210-404-9399
Mailing Address - Fax:210-481-7175
Practice Address - Street 1:1731 N COMAL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4214
Practice Address - Country:US
Practice Address - Phone:210-404-9399
Practice Address - Fax:210-481-7175
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX013301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical