Provider Demographics
NPI:1639877210
Name:PEREZ, CARMEN LYDIA (TRABAJADOR SOCIAL)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:LYDIA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:TRABAJADOR SOCIAL
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:LYDIA
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TRABAJO SOCIAL
Mailing Address - Street 1:PO BOX 71474
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8574
Mailing Address - Country:US
Mailing Address - Phone:787-641-0773
Mailing Address - Fax:
Practice Address - Street 1:PLAZA DEL MAR, CARR. 107, KM. 2.3
Practice Address - Street 2:
Practice Address - City:AGUADILLA CITY
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-641-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR160591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical