Provider Demographics
NPI:1619907573
Name:PERINO, JOSEPH
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:PERINO
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:
Other - Last Name:PERINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-0120
Mailing Address - Country:US
Mailing Address - Phone:631-689-9424
Mailing Address - Fax:
Practice Address - Street 1:233 UNION AVE
Practice Address - Street 2:STE. 101
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1820
Practice Address - Country:US
Practice Address - Phone:631-689-9424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004608103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical