Active NPI
Susan Woodford Perez, LCSW
- Clinical Social Worker
- Petersburg, VA
National Provider Identifier
1063473296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 0904003464
- Practice address
- 26317 W Washington St
Petersburg, VA 23803-2727 - Phone
- (804) 921-2100
- NPI assigned
- Mar 29, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0904003464 | VA | Primary |
Addresses
Primary practice location
26317 W Washington St
Petersburg, VA 23803-2727
Mailing address
PO Box 711
West Point, VA 23181-0711
Phone (804) 921-2100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008930651 | Medicaid | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0904003464 | VA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335225600000",
"number": "1063473296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 711",
"city": "WEST POINT",
"state": "VA",
"postal_code": "231810711",
"telephone_number": "804-921-2100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26317 W WASHINGTON ST",
"city": "PETERSBURG",
"state": "VA",
"postal_code": "238032727",
"telephone_number": "804-921-2100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREZ",
"first_name": "SUSAN",
"middle_name": "WOODFORD",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-29",
"last_updated": "2012-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904003464",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008930651",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Petersburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.