Provider Demographics
NPI:1952651408
Name:PEREZ, VALERIE (PSYD/ HSPP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PSYD/ HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10208 S INDIANAPOLIS AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-6033
Mailing Address - Country:US
Mailing Address - Phone:866-413-1988
Mailing Address - Fax:866-628-8599
Practice Address - Street 1:1101 CUMBERLAND XING STE 108
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2356
Practice Address - Country:US
Practice Address - Phone:866-413-1988
Practice Address - Fax:866-628-8599
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009045103T00000X
IN20042756A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201228740Medicaid
INPENDINGMedicaid