Provider Demographics
NPI:1104597624
Name:PEREZ SMITH, ALBA D (LICSW)
Entity type:Individual
Prefix:
First Name:ALBA
Middle Name:D
Last Name:PEREZ SMITH
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:ALBA
Other - Middle Name:D
Other - Last Name:VARGAS PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:383 W FOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-3515
Mailing Address - Country:US
Mailing Address - Phone:401-400-1863
Mailing Address - Fax:
Practice Address - Street 1:383 W FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-3515
Practice Address - Country:US
Practice Address - Phone:401-400-1863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW043931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical