Provider Demographics
NPI:1730658683
Name:PEREZ, JUAN MANUEL (LCSW)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:MANUEL
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 WADDELL WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-1487
Mailing Address - Country:US
Mailing Address - Phone:209-585-8665
Mailing Address - Fax:
Practice Address - Street 1:875 GEER RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-3311
Practice Address - Country:US
Practice Address - Phone:209-633-3031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA826311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical