Provider Demographics
NPI:1578380010
Name:PEREZ, ESMERALDA M (LPC)
Entity type:Individual
Prefix:
First Name:ESMERALDA
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 S KATELYN CIR APT 101
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-5514
Mailing Address - Country:US
Mailing Address - Phone:414-737-0941
Mailing Address - Fax:
Practice Address - Street 1:4840 S KATELYN CIR APT 101
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-5514
Practice Address - Country:US
Practice Address - Phone:414-737-0941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11040-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health