Provider Demographics
NPI:1508077637
Name:PERRY, MARY ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:PERRY
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 1:11070 MARIN ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33156-4228
Mailing Address - Country:US
Mailing Address - Phone:305-668-2921
Mailing Address - Fax:
Practice Address - Street 1:9769 S DIXIE HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-5600
Practice Address - Country:US
Practice Address - Phone:305-666-3350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0005368103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist