Provider Demographics
NPI:1104299478
Name:PEREZ, CYGRID KRISTIE (LCSW)
Entity type:Individual
Prefix:
First Name:CYGRID
Middle Name:KRISTIE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 W JOHNSON RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-2026
Mailing Address - Country:US
Mailing Address - Phone:219-809-0333
Mailing Address - Fax:219-809-0334
Practice Address - Street 1:245 W JOHNSON RD
Practice Address - Street 2:SUITE 9
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-2026
Practice Address - Country:US
Practice Address - Phone:219-809-0333
Practice Address - Fax:219-809-0334
Is Sole Proprietor?:No
Enumeration Date:2015-11-08
Last Update Date:2015-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005956A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical