Provider Demographics
NPI:1497816219
Name:PERLS, JEFF (LCSWR)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:
Last Name:PERLS
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4627
Mailing Address - Country:US
Mailing Address - Phone:845-340-0244
Mailing Address - Fax:845-340-0141
Practice Address - Street 1:465 BROADWAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4627
Practice Address - Country:US
Practice Address - Phone:845-340-0244
Practice Address - Fax:845-340-0141
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR037224104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN8M241Medicare PIN
R86390Medicare UPIN
NYR86390Medicare UPIN