Provider Demographics
NPI:1720410368
Name:PERKINS, MARY BERGERUD (LICSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BERGERUD
Last Name:PERKINS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 HIGHWAY 7 RM 235
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55305-4737
Mailing Address - Country:US
Mailing Address - Phone:952-988-4177
Mailing Address - Fax:952-988-6728
Practice Address - Street 1:1001 HIGHWAY 7 RM 235
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55305-4737
Practice Address - Country:US
Practice Address - Phone:952-988-4177
Practice Address - Fax:952-988-6728
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
N/AOtherACADEMY OF CERTIFIED SOCIAL WORKERS