Provider Demographics
NPI:1396923876
Name:PERALES, JOSEPH (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:PERALES
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 1:30 HARRIMAN DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924
Mailing Address - Country:US
Mailing Address - Phone:845-291-2143
Mailing Address - Fax:845-291-4145
Practice Address - Street 1:141 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-6204
Practice Address - Country:US
Practice Address - Phone:845-568-5260
Practice Address - Fax:845-568-5213
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0721031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02973522Medicaid