Provider Demographics
NPI:1063191393
Name:PEREZ, JUAN FRANCISCO (LMSW)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:FRANCISCO
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 GRAND ST APT 4L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-4962
Mailing Address - Country:US
Mailing Address - Phone:786-486-3101
Mailing Address - Fax:
Practice Address - Street 1:766 GRAND ST APT 4L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-4962
Practice Address - Country:US
Practice Address - Phone:786-486-3101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120055104100000X
NJ44SL06996300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker