Provider Demographics
NPI:1861035586
Name:PERKINS, ANDREA MN (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MN
Last Name:PERKINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARGARET NICOLE
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:SJC BHS BACOP
Mailing Address - Street 2:1149 EL DORADO STREET
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202
Mailing Address - Country:US
Mailing Address - Phone:209-468-2337
Mailing Address - Fax:209-953-7400
Practice Address - Street 1:SJC BHS BACOP
Practice Address - Street 2:1149 EL DORADO STREET
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202
Practice Address - Country:US
Practice Address - Phone:209-468-2337
Practice Address - Fax:209-953-7400
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA695711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical