Provider Demographics
NPI:1952473944
Name:PEREZ, ANTHONY (LCSW MSW R)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LCSW MSW R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 MORTON ST
Mailing Address - Street 2:
Mailing Address - City:GARNERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10923-1428
Mailing Address - Country:US
Mailing Address - Phone:845-947-1357
Mailing Address - Fax:
Practice Address - Street 1:53 MORTON ST
Practice Address - Street 2:
Practice Address - City:GARNERVILLE
Practice Address - State:NY
Practice Address - Zip Code:10923-1428
Practice Address - Country:US
Practice Address - Phone:845-947-1357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR288041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
7323442OtherOXFORD
1030790OtherBEACON
54317000OtherMAGEUAN
1030790OtherBEACON