Provider Demographics
NPI:1790226355
Name:PEREZ, STEPHENIE (LMSW)
Entity Type:Individual
Prefix:
First Name:STEPHENIE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 KINGS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:NY
Mailing Address - Zip Code:10548-1210
Mailing Address - Country:US
Mailing Address - Phone:347-247-7261
Mailing Address - Fax:
Practice Address - Street 1:180 KINGS FERRY RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:NY
Practice Address - Zip Code:10548-1210
Practice Address - Country:US
Practice Address - Phone:347-247-7261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096865-1104100000X
NY091167-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker