Provider Demographics
NPI:1073728721
Name:PERRY, RICKEY L (MSW)
Entity Type:Individual
Prefix:
First Name:RICKEY
Middle Name:L
Last Name:PERRY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 ALLEN LN, SUITE 3
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2229
Mailing Address - Country:US
Mailing Address - Phone:702-385-1072
Mailing Address - Fax:702-385-3053
Practice Address - Street 1:4455 ALLEN LN, SUITE 3
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2229
Practice Address - Country:US
Practice Address - Phone:702-385-1072
Practice Address - Fax:702-385-3053
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2651-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical