Provider Demographics
NPI:1558472704
Name:PEREZ, EDUARDO M (LCSW#16741)
Entity type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LCSW#16741
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3613
Mailing Address - Country:US
Mailing Address - Phone:951-955-4395
Mailing Address - Fax:951-955-2138
Practice Address - Street 1:4275 LEMON ST
Practice Address - Street 2:SUITE #205
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3844
Practice Address - Country:US
Practice Address - Phone:951-955-8541
Practice Address - Fax:951-955-8542
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA164711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical