Provider Demographics
NPI:1891568267
Name:PERREAULT, TIARA-ELIZABETH DOROTHY
Entity Type:Individual
Prefix:
First Name:TIARA-ELIZABETH
Middle Name:DOROTHY
Last Name:PERREAULT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 DEVENS ST
Mailing Address - Street 2:
Mailing Address - City:INDIAN ORCHARD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-2303
Mailing Address - Country:US
Mailing Address - Phone:413-668-6740
Mailing Address - Fax:
Practice Address - Street 1:3 DEVENS ST
Practice Address - Street 2:
Practice Address - City:INDIAN ORCHARD
Practice Address - State:MA
Practice Address - Zip Code:01151-2303
Practice Address - Country:US
Practice Address - Phone:413-668-6740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health