Provider Demographics
NPI:1114031499
Name:PERRIN, JANE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:E
Last Name:PERRIN
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 1:3608 W FRIENDLY AVE
Mailing Address - Street 2:SUITE #208
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4865
Mailing Address - Country:US
Mailing Address - Phone:336-299-1115
Mailing Address - Fax:336-299-5559
Practice Address - Street 1:3608 W FRIENDLY AVE
Practice Address - Street 2:SUITE #208
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4865
Practice Address - Country:US
Practice Address - Phone:336-299-1115
Practice Address - Fax:336-299-5559
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1102103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC04388OtherBLUE CROSS BLUE SHIELD
NC2812342Medicare ID - Type Unspecified