Provider Demographics
NPI:1659471670
Name:PERRY, SUMMER NERISSA (PHD, MFT)
Entity Type:Individual
Prefix:DR
First Name:SUMMER
Middle Name:NERISSA
Last Name:PERRY
Suffix:
Gender:F
Credentials:PHD, MFT
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 1256
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91025-4256
Mailing Address - Country:US
Mailing Address - Phone:626-395-9490
Mailing Address - Fax:626-395-9490
Practice Address - Street 1:350 E CALIFORNIA BLVD
Practice Address - Street 2:118
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-3604
Practice Address - Country:US
Practice Address - Phone:626-395-9490
Practice Address - Fax:626-395-9490
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 20625106H00000X
GALMFT 000724106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist