Provider Demographics
NPI:1831915792
Name:PEREZ, ALYIA BROOKE (LMSW)
Entity type:Individual
Prefix:
First Name:ALYIA
Middle Name:BROOKE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 N GARDINER DR APT 18B
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-1425
Mailing Address - Country:US
Mailing Address - Phone:845-551-4652
Mailing Address - Fax:
Practice Address - Street 1:1739 N GARDINER DR APT 18B
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-1425
Practice Address - Country:US
Practice Address - Phone:845-551-4652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125325104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker