Provider Demographics
NPI:1790177830
Name:PERKINS, LISA J (LICSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:PERKINS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GREENEEDLE LN
Mailing Address - Street 2:
Mailing Address - City:DENNIS PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02639-1842
Mailing Address - Country:US
Mailing Address - Phone:774-212-5715
Mailing Address - Fax:508-433-1871
Practice Address - Street 1:411 ROUTE 6A BLDG 5 UNIT C
Practice Address - Street 2:
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-1843
Practice Address - Country:US
Practice Address - Phone:774-212-5715
Practice Address - Fax:508-433-1871
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical