Provider Demographics
NPI:1639170327
Name:PEREZ, LESLIE A (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:A
Other - Last Name:BENDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5190 BAYOU BLVD
Mailing Address - Street 2:BLDG 6
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2194
Mailing Address - Country:US
Mailing Address - Phone:850-476-0977
Mailing Address - Fax:850-476-2558
Practice Address - Street 1:5190 BAYOU BLVD
Practice Address - Street 2:BLDG 6
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2194
Practice Address - Country:US
Practice Address - Phone:850-476-0977
Practice Address - Fax:850-476-2558
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW81241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical