Provider Demographics
NPI:1831130822
Name:PEREZ, JOSE ANTONIO (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ANTONIO
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LCSW
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Other - First Name:
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Mailing Address - Street 1:55 WATER STREET
Mailing Address - Street 2:2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:88-31 55TH AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4686
Practice Address - Country:US
Practice Address - Phone:718-899-6600
Practice Address - Fax:718-606-3881
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYR0760911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical