Provider Demographics
NPI:1225607013
Name:PEREZ, MANUEL JOSEPH (LCSW)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:JOSEPH
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27194 BASELINE ST STE D
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-3197
Mailing Address - Country:US
Mailing Address - Phone:909-253-9963
Mailing Address - Fax:
Practice Address - Street 1:27194 BASELINE ST STE D
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-3197
Practice Address - Country:US
Practice Address - Phone:909-903-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101144261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)