Provider Demographics
NPI:1588958128
Name:PEREZ, JULIETA P (LCSW)
Entity type:Individual
Prefix:
First Name:JULIETA
Middle Name:P
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 N MILWAUKEE AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7886
Mailing Address - Country:US
Mailing Address - Phone:800-206-8136
Mailing Address - Fax:708-575-3167
Practice Address - Street 1:2923 N MILWAUKEE AVE STE 302
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-7886
Practice Address - Country:US
Practice Address - Phone:773-567-9763
Practice Address - Fax:312-873-4749
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.016540OtherLICENSE CLINICAL SOCIAL WORKER
IL1588958128Medicaid
IL1588958128Medicaid