Individual
MR. VIDAL P PEREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
645 ELMWOOD AVE, PROVIDENCE, RI 02907-3313
(401) 467-8094
(401) 467-8857
Mailing address
645 ELMWOOD AVE, PROVIDENCE, RI 02907-3313
(401) 467-8094
(401) 467-8857
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ISW 00915
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1021380
NHP RI PROVIDER NUMBER
RI
01
—
21072-4
BC/BS PROVIDER NUMBER
RI
01
—
6251061
UBH PROVIDER NUMBER
RI
Enumeration date
08/08/2006
Last updated
03/16/2012
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