Provider Demographics
NPI:1932588910
Name:PEREZ, ROEL (LBSW)
Entity type:Individual
Prefix:
First Name:ROEL
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 E GRIFFIN PKWY
Mailing Address - Street 2:SUITE 12
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3241
Mailing Address - Country:US
Mailing Address - Phone:956-598-8190
Mailing Address - Fax:956-627-5655
Practice Address - Street 1:2121 E GRIFFIN PKWY
Practice Address - Street 2:SUITE 12
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3241
Practice Address - Country:US
Practice Address - Phone:956-598-8190
Practice Address - Fax:956-627-5655
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-25
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29433171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator