Provider Demographics
NPI:1386962579
Name:PERAK, JOHN JAMES (LCSWR)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JAMES
Last Name:PERAK
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 RANSOMVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RANSOMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14131-9602
Mailing Address - Country:US
Mailing Address - Phone:716-791-3571
Mailing Address - Fax:
Practice Address - Street 1:3509 RANSOMVILLE RD
Practice Address - Street 2:
Practice Address - City:RANSOMVILLE
Practice Address - State:NY
Practice Address - Zip Code:14131
Practice Address - Country:US
Practice Address - Phone:716-791-3571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0353741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1386962579Medicare NSC