Provider Demographics
NPI:1942390489
Name:PEREZ, LUCY (LISAC)
Entity Type:Individual
Prefix:MS
First Name:LUCY
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 E BUCKEYE RD
Mailing Address - Street 2:CHICANOS POR LA CAUSA, INC
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-4041
Mailing Address - Country:US
Mailing Address - Phone:602-254-4827
Mailing Address - Fax:602-257-6796
Practice Address - Street 1:4602 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITES C-3, C-4, AND D-2
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-2838
Practice Address - Country:US
Practice Address - Phone:623-247-0464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ102491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical