Provider Demographics
NPI:1902229487
Name:PERNA, STELLA ELIZABETH (EDS)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:ELIZABETH
Last Name:PERNA
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:958 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43526-1258
Mailing Address - Country:US
Mailing Address - Phone:419-542-7475
Mailing Address - Fax:419-542-8711
Practice Address - Street 1:958 E HIGH ST
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43526-1258
Practice Address - Country:US
Practice Address - Phone:419-542-7475
Practice Address - Fax:419-542-8711
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1222826103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool