Provider Demographics
NPI:1811385214
Name:PEREZ, JEANETTE (LCSW, LPHA)
Entity Type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LCSW, LPHA
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4732 N AUSTIN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3785
Mailing Address - Country:US
Mailing Address - Phone:847-340-9908
Mailing Address - Fax:
Practice Address - Street 1:1116 N KEDZIE AV. OFFICE#257
Practice Address - Street 2:ASSOCIATION HOUSE OF CHICAGO
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651
Practice Address - Country:US
Practice Address - Phone:773-772-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490155611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical