Provider Demographics
NPI:1164045100
Name:PERENNIAL WELLNESS PLLC
Entity Type:Organization
Organization Name:PERENNIAL WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-462-1910
Mailing Address - Street 1:21 LITTLE FOX LN
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-3222
Mailing Address - Country:US
Mailing Address - Phone:617-462-1910
Mailing Address - Fax:
Practice Address - Street 1:250 POST RD E STE 106
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3616
Practice Address - Country:US
Practice Address - Phone:617-462-1910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty