Provider Demographics
NPI:1720792872
Name:PEREZ, LINDSAY NICHOLE
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:NICHOLE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-0597
Mailing Address - Country:US
Mailing Address - Phone:570-323-6944
Mailing Address - Fax:
Practice Address - Street 1:1902 OLDE HOMESTEAD LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-5875
Practice Address - Country:US
Practice Address - Phone:877-907-7970
Practice Address - Fax:866-902-3285
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW141559104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker