Provider Demographics
NPI:1811395478
Name:PEREZ, IRENE MARIA
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:MARIA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2445
Mailing Address - Country:US
Mailing Address - Phone:810-424-4670
Mailing Address - Fax:810-257-1325
Practice Address - Street 1:705 S DORT HWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2852
Practice Address - Country:US
Practice Address - Phone:810-257-1325
Practice Address - Fax:810-257-1347
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010967661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical