Provider Demographics
NPI:1710309646
Name:PERRIN, PAUL BERNARD
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:BERNARD
Last Name:PERRIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 W GRACE ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4911
Mailing Address - Country:US
Mailing Address - Phone:804-783-0678
Mailing Address - Fax:804-783-2514
Practice Address - Street 1:517 W GRACE ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4911
Practice Address - Country:US
Practice Address - Phone:804-783-0678
Practice Address - Fax:804-783-2514
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004907103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist