Provider Demographics
NPI:1932810884
Name:PEREZ, PATRICIA ROSE (CPSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ROSE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:CPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N SILVER ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-6779
Mailing Address - Country:US
Mailing Address - Phone:575-956-6131
Mailing Address - Fax:575-956-4971
Practice Address - Street 1:610 N SILVER ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-6779
Practice Address - Country:US
Practice Address - Phone:575-956-6131
Practice Address - Fax:575-956-4971
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1446104100000X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker