Provider Demographics
NPI:1457477531
Name:PERKINS, MARLYN (PHD)
Entity Type:Individual
Prefix:
First Name:MARLYN
Middle Name:
Last Name:PERKINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARLY
Other - Middle Name:
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1303 JEFFERSON ST
Mailing Address - Street 2:SUITE 600A
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-2442
Mailing Address - Country:US
Mailing Address - Phone:415-706-3737
Mailing Address - Fax:
Practice Address - Street 1:1303 JEFFERSON ST
Practice Address - Street 2:SUITE 600A
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2442
Practice Address - Country:US
Practice Address - Phone:415-706-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7149103T00000X, 103TB0200X, 103TF0000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily