Provider Demographics
NPI:1487854360
Name:PEREZ, JOSE ANTONIO (CASAC # 18600)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ANTONIO
Last Name:PEREZ
Suffix:
Gender:M
Credentials:CASAC # 18600
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:202 FLATBUSH AVE # 206
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2177
Mailing Address - Country:US
Mailing Address - Phone:718-398-0800
Mailing Address - Fax:718-789-8807
Practice Address - Street 1:202 FLATBUSH AVE # 206
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2177
Practice Address - Country:US
Practice Address - Phone:718-398-0800
Practice Address - Fax:718-789-8807
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18600101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)