Provider Demographics
NPI:1114070265
Name:PERRINE, EMILY ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ELIZABETH
Last Name:PERRINE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:MOLINA
Other - Last Name:GIFFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1320 SEACOAST DRIVE
Mailing Address - Street 2:UNIT M
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932-3193
Mailing Address - Country:US
Mailing Address - Phone:619-925-9875
Mailing Address - Fax:
Practice Address - Street 1:1320 SEACOAST DRIVE
Practice Address - Street 2:UNIT M
Practice Address - City:IMPERIAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:91932-3193
Practice Address - Country:US
Practice Address - Phone:619-925-9875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPS2006169103TC0700X
CAPSB32507103TC0700X
CACAPSY23363103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical