Provider Demographics
NPI:1306439930
Name:PEREZ, MARIANA (MSW)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 1 C-14 URB. VILLA MATILDE
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-2312
Mailing Address - Country:US
Mailing Address - Phone:787-371-0733
Mailing Address - Fax:
Practice Address - Street 1:CALLE 1 C-14 URB. VILLA MATILDE
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-2312
Practice Address - Country:US
Practice Address - Phone:787-371-0733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13350104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker