Provider Demographics
NPI:1336765460
Name:PEREZ, MICHAEL GABRIEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GABRIEL
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12204 SW 95TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1927
Mailing Address - Country:US
Mailing Address - Phone:305-491-2903
Mailing Address - Fax:
Practice Address - Street 1:10250 SW 56TH ST STE C
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7069
Practice Address - Country:US
Practice Address - Phone:305-271-8509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW171661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical