Provider Demographics
NPI:1790052017
Name:PERIOLI, MEGAN LYNN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:LYNN
Last Name:PERIOLI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:LYNN
Other - Last Name:LORTIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:61 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1117
Mailing Address - Country:US
Mailing Address - Phone:315-783-6986
Mailing Address - Fax:
Practice Address - Street 1:8219 MARKET PL BLDG 10
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104
Practice Address - Country:US
Practice Address - Phone:315-692-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006471101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health