Provider Demographics
NPI:1235453036
Name:PERUMBILLY, SEBASTIAN ANTONY (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:ANTONY
Last Name:PERUMBILLY
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2552
Mailing Address - Country:US
Mailing Address - Phone:206-446-8865
Mailing Address - Fax:
Practice Address - Street 1:17 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2552
Practice Address - Country:US
Practice Address - Phone:206-446-8865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1532106H00000X
WALF60102597106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist