Provider Demographics
NPI:1891908109
Name:PERILLO, MAGDA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MAGDA
Middle Name:
Last Name:PERILLO
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 1:231 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2235
Mailing Address - Country:US
Mailing Address - Phone:732-986-2731
Mailing Address - Fax:201-652-2187
Practice Address - Street 1:115 PINE ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-1619
Practice Address - Country:US
Practice Address - Phone:201-493-1700
Practice Address - Fax:201-652-2187
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047785001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical