Provider Demographics
NPI:1588964365
Name:PEREZ, DIANE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
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:PO BOX 63087
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063-0087
Mailing Address - Country:US
Mailing Address - Phone:818-988-6335
Mailing Address - Fax:818-988-6817
Practice Address - Street 1:6551 VAN NUYS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1442
Practice Address - Country:US
Practice Address - Phone:818-988-6335
Practice Address - Fax:818-988-6817
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical