Provider Demographics
NPI:1750832846
Name:PERANTEAU, LAURA JEANNE (MS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEANNE
Last Name:PERANTEAU
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4247 LOCUST ST
Mailing Address - Street 2:APT 508
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5252
Mailing Address - Country:US
Mailing Address - Phone:860-463-5553
Mailing Address - Fax:
Practice Address - Street 1:4247 LOCUST ST
Practice Address - Street 2:APT 508
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5252
Practice Address - Country:US
Practice Address - Phone:215-469-1146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health