Provider Demographics
NPI:1669894416
Name:PEREZ, ANA (LCSW)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6633 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-1324
Mailing Address - Country:US
Mailing Address - Phone:917-670-8010
Mailing Address - Fax:
Practice Address - Street 1:6633 ROSE ST
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-1324
Practice Address - Country:US
Practice Address - Phone:917-670-8010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073910-1104100000X
TX58327104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker