Provider Demographics
NPI:1598880700
Name:PERRY, LYNNE ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:ELLEN
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 1:1407 WEST FOOTHILL BLVD
Mailing Address - Street 2:SUITE 32
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750
Mailing Address - Country:US
Mailing Address - Phone:909-519-2787
Mailing Address - Fax:909-596-1809
Practice Address - Street 1:225 N EUCLID BLVD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91286
Practice Address - Country:US
Practice Address - Phone:909-519-2787
Practice Address - Fax:909-596-1809
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7788103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical