Provider Demographics
NPI:1760574842
Name:PERA, MEGAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:
Last Name:PERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3481 S DIXIE HWY # 256
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-5717
Mailing Address - Country:US
Mailing Address - Phone:937-507-6520
Mailing Address - Fax:937-889-2895
Practice Address - Street 1:3481 S DIXIE HWY # 256
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-5717
Practice Address - Country:US
Practice Address - Phone:937-889-2895
Practice Address - Fax:937-507-6520
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0106571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0206382Medicaid