Provider Demographics
NPI:1730492117
Name:PINNA-PEREZ, ANGELICA (PHD, LICSW, LCAT)
Entity Type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:
Last Name:PINNA-PEREZ
Suffix:
Gender:F
Credentials:PHD, LICSW, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 CENTRAL ST STE 403B
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1917
Mailing Address - Country:US
Mailing Address - Phone:617-996-8119
Mailing Address - Fax:
Practice Address - Street 1:97 CENTRAL ST STE 403B
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1917
Practice Address - Country:US
Practice Address - Phone:617-996-8119
Practice Address - Fax:617-925-6367
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05 001563104100000X
NY0808791041C0700X
MA1184131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker