Provider Demographics
NPI:1790441673
Name:PERNINI, PAULINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAULINE
Middle Name:
Last Name:PERNINI
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 1:134 MAIN ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-1694
Mailing Address - Country:US
Mailing Address - Phone:908-892-4517
Mailing Address - Fax:
Practice Address - Street 1:134 MAIN ST STE 3A
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1694
Practice Address - Country:US
Practice Address - Phone:908-892-4517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SCO4549800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health