Provider Demographics
NPI:1376758284
Name:JAMES M PERKIN LICENSED PSYCHOLOGIST
Entity Type:Organization
Organization Name:JAMES M PERKIN LICENSED PSYCHOLOGIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:PERKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:610-432-6687
Mailing Address - Street 1:4825 TILGHMAN ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104
Mailing Address - Country:US
Mailing Address - Phone:610-432-6687
Mailing Address - Fax:610-366-2049
Practice Address - Street 1:4825 TILGHMAN ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104
Practice Address - Country:US
Practice Address - Phone:610-432-6687
Practice Address - Fax:610-366-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004611L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01469898Medicaid
R05937Medicare UPIN
PA026380Medicare ID - Type Unspecified