Provider Demographics
NPI:1730283987
Name:PERERA, LISA DENNY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:DENNY
Last Name:PERERA
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 1:676 PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215
Mailing Address - Country:US
Mailing Address - Phone:718-638-2062
Mailing Address - Fax:
Practice Address - Street 1:441 WEST 26TH ST
Practice Address - Street 2:HUDSON GUILD
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:212-760-9822
Practice Address - Fax:212-760-9826
Is Sole Proprietor?:No
Enumeration Date:2006-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0576211104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00057621Medicaid
NY00057621Medicaid