Provider Demographics
NPI:1629791322
Name:PERRY, AQUAYA S (MHC)
Entity Type:Individual
Prefix:
First Name:AQUAYA
Middle Name:S
Last Name:PERRY
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:AQUAYA
Other - Middle Name:S
Other - Last Name:PERRY-BROOKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:41A W MERRICK RD STE 2
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5708
Mailing Address - Country:US
Mailing Address - Phone:516-459-2920
Mailing Address - Fax:516-285-1616
Practice Address - Street 1:41B W MERRICK RD STE 2
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5756
Practice Address - Country:US
Practice Address - Phone:516-459-2920
Practice Address - Fax:516-285-1616
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116965101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health