Provider Demographics
NPI:1528117769
Name:PEREIRA, EDUARDO V (LCSW)
Entity type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:V
Last Name:PEREIRA
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 1:1814 W 500 N
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-9107
Mailing Address - Country:US
Mailing Address - Phone:765-664-7364
Mailing Address - Fax:
Practice Address - Street 1:101 S WASHINGTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3867
Practice Address - Country:US
Practice Address - Phone:765-662-9971
Practice Address - Fax:765-651-6566
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001263A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000004027OtherMPLAN PROV ID
IN158079OtherVALUE OPTIONS PROV ID
IN0005477491OtherAETNA PROVIDER ID
IN088367428001OtherGENERAL LIC #
INI014647OtherTRICARE PROVIDER ID
IN000000183231OtherANTHEM PROVIDER ID
INLIC34001263AOtherGENERAL MOTORS PROV ID
IN000000317611OtherGENCORP PROVIDER ID
IN0005477491OtherAETNA PROVIDER ID