Provider Demographics
NPI:1063056695
Name:PEREZ SCHNEIDER, KIM
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:PEREZ SCHNEIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10142 HAVERHILL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-2120
Mailing Address - Country:US
Mailing Address - Phone:813-340-1283
Mailing Address - Fax:813-626-0067
Practice Address - Street 1:10142 HAVERHILL RIDGE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-2120
Practice Address - Country:US
Practice Address - Phone:813-340-1283
Practice Address - Fax:813-626-0067
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW000046561041C0700X
FLSS1056103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical