Provider Demographics
NPI:1124421425
Name:PEREYRA-PITTS, MARIANA (LICSW, LCSW)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:PEREYRA-PITTS
Suffix:
Gender:F
Credentials:LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17706 ICELAND TRL
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-9686
Mailing Address - Country:US
Mailing Address - Phone:510-295-8440
Mailing Address - Fax:
Practice Address - Street 1:18432 KENRICK AVE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-9288
Practice Address - Country:US
Practice Address - Phone:952-992-6703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1099261041C0700X
171M00000X
MN284171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator