Provider Demographics
NPI:1750446977
Name:PERERA, SYLVIA BRINTON (LP)
Entity Type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:BRINTON
Last Name:PERERA
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 S PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-658-3925
Mailing Address - Fax:802-658-3525
Practice Address - Street 1:153 EAST 87 ST
Practice Address - Street 2:SUITE 5D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2705
Practice Address - Country:US
Practice Address - Phone:212-831-4885
Practice Address - Fax:212-831-4885
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000636-1103TP0814X
VT098-0000123103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis