Provider Demographics
NPI:1437355518
Name:PERROTTA, KATHRYN JILL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:JILL
Last Name:PERROTTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 S FRENCH BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-3272
Mailing Address - Country:US
Mailing Address - Phone:828-808-9780
Mailing Address - Fax:828-274-0015
Practice Address - Street 1:53 S FRENCH BROAD AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3272
Practice Address - Country:US
Practice Address - Phone:828-808-9780
Practice Address - Fax:828-274-0015
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0047081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002884Medicaid