Provider Demographics
NPI:1346664133
Name:PERKINS, JESSICA (CASAC 22175)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PERKINS
Suffix:
Gender:F
Credentials:CASAC 22175
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:SPRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17A KING ST
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12885-1420
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 ELM ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3670
Practice Address - Country:US
Practice Address - Phone:518-793-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22175101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420800Medicaid