Provider Demographics
NPI:1215601653
Name:PEREZ, EMMANUEL (MA)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:MANNY
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:2150 W LAWRENCE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1582
Mailing Address - Country:US
Mailing Address - Phone:773-887-6447
Mailing Address - Fax:
Practice Address - Street 1:2150 W LAWRENCE AVE STE A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1582
Practice Address - Country:US
Practice Address - Phone:773-887-6447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty