Provider Demographics
NPI:1780831834
Name:PERRIS, JOANNA C
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:C
Last Name:PERRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 BELLEVILLE AVE
Mailing Address - Street 2:#31
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3652
Mailing Address - Country:US
Mailing Address - Phone:917-767-1730
Mailing Address - Fax:
Practice Address - Street 1:324 BELLEVILLE AVENUE
Practice Address - Street 2:#31
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003
Practice Address - Country:US
Practice Address - Phone:917-767-1730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053206001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical