Provider Demographics
NPI:1972055093
Name:PEREZ, YVONNE (MSW, RCSWI)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MSW, RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 N BOUNDARY BLVD STE 128
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33621-5050
Mailing Address - Country:US
Mailing Address - Phone:813-787-4046
Mailing Address - Fax:
Practice Address - Street 1:3108 N BOUNDARY BLVD STE 128
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33621-5050
Practice Address - Country:US
Practice Address - Phone:813-787-4046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14800ISW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical