Provider Demographics
NPI:1346643947
Name:PERUCCI, TAFFY
Entity Type:Individual
Prefix:MRS
First Name:TAFFY
Middle Name:
Last Name:PERUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92-523 WAOKELE ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-3401
Mailing Address - Country:US
Mailing Address - Phone:808-226-1155
Mailing Address - Fax:
Practice Address - Street 1:92-523 WAOKELE ST
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-3401
Practice Address - Country:US
Practice Address - Phone:808-226-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-27
Last Update Date:2014-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst