Provider Demographics
NPI:1942465059
Name:PERALES, ANGELA M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:M
Last Name:PERALES
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 1:800 WOODHILLS DR APT 811
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-1464
Mailing Address - Country:US
Mailing Address - Phone:845-222-5679
Mailing Address - Fax:
Practice Address - Street 1:60 ERIE ST STE 403
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-1531
Practice Address - Country:US
Practice Address - Phone:845-222-5679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2018-04-30
Deactivation Date:2018-02-08
Deactivation Code:
Reactivation Date:2018-02-13
Provider Licenses
StateLicense IDTaxonomies
NY0810751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical