Provider Demographics
NPI:1861677718
Name:PEREZ, GLICERIA G (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GLICERIA
Middle Name:G
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 RARITAN AVE STE 204C
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2752
Mailing Address - Country:US
Mailing Address - Phone:732-991-3763
Mailing Address - Fax:
Practice Address - Street 1:320 RARITAN AVE STE 204C
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2752
Practice Address - Country:US
Practice Address - Phone:732-991-3763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05417200104100000X
NJ44SL055469001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker