Provider Demographics
NPI:1063649960
Name:PERKINS, CLARA WHALEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:CLARA
Middle Name:WHALEY
Last Name:PERKINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2047 WALLACE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3221
Mailing Address - Country:US
Mailing Address - Phone:215-232-6216
Mailing Address - Fax:215-787-9911
Practice Address - Street 1:2047 WALLACE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3221
Practice Address - Country:US
Practice Address - Phone:215-232-6216
Practice Address - Fax:215-787-9911
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004284-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist