Provider Demographics
NPI:1679061428
Name:LILLIAN PEREZ, LCSW
Entity Type:Organization
Organization Name:LILLIAN PEREZ, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEREZ
Authorized Official - Middle Name:
Authorized Official - Last Name:LILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-538-9234
Mailing Address - Street 1:13542 N FLORIDA AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3263
Mailing Address - Country:US
Mailing Address - Phone:813-538-9234
Mailing Address - Fax:
Practice Address - Street 1:13542 N FLORIDA AVE STE 210
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3263
Practice Address - Country:US
Practice Address - Phone:813-538-9234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW14622104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty