Provider Demographics
NPI:1447606751
Name:PERERA, MANASA K (PHD)
Entity Type:Individual
Prefix:DR
First Name:MANASA
Middle Name:K
Last Name:PERERA
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 1:820 SHANNON LAKE CT
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-2593
Mailing Address - Country:US
Mailing Address - Phone:312-515-7841
Mailing Address - Fax:
Practice Address - Street 1:820 SHANNON LAKE CT
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-2593
Practice Address - Country:US
Practice Address - Phone:312-515-7841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009262103TC0700X
IL071.009262103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071009262OtherILLINOIS LICENSURE FOR CLINICAL PSYCHOLOGIST