Provider Demographics
NPI:1649485822
Name:PEREZ, KAREN (MSW)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32450 TALIMENA LOOP
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-5839
Mailing Address - Country:US
Mailing Address - Phone:813-493-7705
Mailing Address - Fax:
Practice Address - Street 1:4830 W KENNEDY BLVD # 634
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2564
Practice Address - Country:US
Practice Address - Phone:813-486-4920
Practice Address - Fax:833-465-0108
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW112541041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117567900Medicaid