Provider Demographics
NPI:1346612330
Name:PERRET, KRISTIN ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:ANNE
Last Name:PERRET
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 1:55 CHERRY LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-1770
Mailing Address - Country:US
Mailing Address - Phone:516-216-9658
Mailing Address - Fax:
Practice Address - Street 1:55 CHERRY LN
Practice Address - Street 2:SUITE 103
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-1770
Practice Address - Country:US
Practice Address - Phone:516-216-9658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021439103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical