Active NPI
Kami Annette Perez, LCSW, LCAS
- Clinical Social Worker
- Fayetteville, NC
National Provider Identifier
1114479839
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C011666
- Practice address
- 3505 Village Dr
Fayetteville, NC 28304-4513 - Phone
- (910) 615-3737
- NPI assigned
- Oct 28, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LCAS-22914 | NC | |
| Clinical Social Worker | 1041C0700X | P010561 | NC | |
| Clinical Social Worker | 1041C0700X | C011666 | NC | Primary |
Addresses
Primary practice location
3505 Village Dr
Fayetteville, NC 28304-4513
Mailing address
3505 Village Dr
Fayetteville, NC 28304-4513
Phone (910) 615-3737
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCAS-22914 | NC | MD | Addiction (Substance Use Disorder) Counselor |
| P010561 | NC | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marvin Behavioral Health Ma PC | Clinical | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Fayetteville, NC
- NPI 1609482439
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1477612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601337600000",
"number": "1114479839",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3505 VILLAGE DR",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283044513",
"telephone_number": "910-615-3737"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3505 VILLAGE DR",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283044513",
"telephone_number": "910-615-3737"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREZ",
"first_name": "KAMI",
"middle_name": "ANNETTE",
"credential": "LCSW, LCAS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-10-28",
"last_updated": "2020-09-29",
"certification_date": "2020-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "LCAS-22914",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "P010561",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C011666",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.