Provider Demographics
NPI:1942646500
Name:PELAEZ, PRISCILA E (MSW)
Entity type:Individual
Prefix:MRS
First Name:PRISCILA
Middle Name:E
Last Name:PELAEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6036 BENT PINE DR APT 3127
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-6850
Mailing Address - Country:US
Mailing Address - Phone:787-485-8847
Mailing Address - Fax:
Practice Address - Street 1:6036 BENT PINE DR APT 3127
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-6850
Practice Address - Country:US
Practice Address - Phone:787-485-8847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2015-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8373104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$Medicaid