Provider Demographics
NPI:1336108471
Name:PERRY, KRISTIN LEIGH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:LEIGH
Last Name:PERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:LEIGH
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6367 OTIS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2240
Mailing Address - Country:US
Mailing Address - Phone:207-838-1859
Mailing Address - Fax:
Practice Address - Street 1:6929 OUTREACH WAY
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-3493
Practice Address - Country:US
Practice Address - Phone:941-371-8820
Practice Address - Fax:941-377-3194
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical