Provider Demographics
NPI:1851905376
Name:PERROTTA, MARIA LYNN (PHD)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:LYNN
Last Name:PERROTTA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 FISHER RD
Mailing Address - Street 2:
Mailing Address - City:PORTERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16051-5904
Mailing Address - Country:US
Mailing Address - Phone:724-651-4562
Mailing Address - Fax:
Practice Address - Street 1:130 W NORTH ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-3906
Practice Address - Country:US
Practice Address - Phone:724-658-3578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012656101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional