Provider Demographics
NPI:1922143569
Name:PERLMUTTER, JOEL DAVID (PHD)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:DAVID
Last Name:PERLMUTTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 LANTERN LN.
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:MA
Mailing Address - Zip Code:01775
Mailing Address - Country:US
Mailing Address - Phone:978-897-9797
Mailing Address - Fax:978-897-9797
Practice Address - Street 1:158 MAIN ST.
Practice Address - Street 2:SUITE #12
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260
Practice Address - Country:US
Practice Address - Phone:860-928-6619
Practice Address - Fax:978-897-9797
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1354103TC0700X
CT602103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004008348Medicaid
CT004008348Medicaid
R38595Medicare UPIN
MAPEW50224Medicare ID - Type Unspecified