Provider Demographics
NPI:1578115887
Name:FIRPO-PERRETTI, YUDELKI MARLIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:YUDELKI
Middle Name:MARLIN
Last Name:FIRPO-PERRETTI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:YUDELKI
Other - Middle Name:MARLIN
Other - Last Name:FIRPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:799 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1048
Mailing Address - Country:US
Mailing Address - Phone:617-674-5313
Mailing Address - Fax:
Practice Address - Street 1:799 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1048
Practice Address - Country:US
Practice Address - Phone:617-674-5313
Practice Address - Fax:617-674-5340
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA11205103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program