Provider Demographics
NPI:1750709416
Name:PEREZ EBRAHIMI, CONCEPCION (MA)
Entity type:Individual
Prefix:
First Name:CONCEPCION
Middle Name:
Last Name:PEREZ EBRAHIMI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 N STATE ROAD 7
Mailing Address - Street 2:201
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5839
Mailing Address - Country:US
Mailing Address - Phone:954-486-4005
Mailing Address - Fax:954-497-3857
Practice Address - Street 1:546 NW UNIVERSITY BLVD
Practice Address - Street 2:SUITE202
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2286
Practice Address - Country:US
Practice Address - Phone:772-361-6767
Practice Address - Fax:954-497-3857
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical