Basic Information
| Provider Information | |||||||||
| NPI: | 1235899147 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | EMANUEL | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 SLEEPY HOLLOW RD | ||||||||
| Address2: | |||||||||
| City: | MARMORA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082231110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033487617 | ||||||||
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| Practice Location | |||||||||
| Address1: | 128 CREST HAVEN RD | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082101651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8444223632 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2021 | ||||||||
| LastUpdateDate: | 12/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 44SC06049200 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.