Provider Demographics
NPI:1689775074
Name:PERATES, JANICE (MSW)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:
Last Name:PERATES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 LYNNWAY APT 310
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1867
Mailing Address - Country:US
Mailing Address - Phone:781-363-1304
Mailing Address - Fax:
Practice Address - Street 1:256 LYNNWAY APT 310
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1867
Practice Address - Country:US
Practice Address - Phone:781-363-1304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10166721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPE P23678Medicare ID - Type UnspecifiedMEDICARE PART B PROVIDER