Provider Demographics
NPI:1639365638
Name:PERRY, PATRICIA (LCSW, ACSW, C-SSWS)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:LCSW, ACSW, C-SSWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70302-6001
Mailing Address - Country:US
Mailing Address - Phone:985-688-3136
Mailing Address - Fax:
Practice Address - Street 1:3135 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-3652
Practice Address - Country:US
Practice Address - Phone:985-688-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA21631041C0700X, 1041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool