Provider Demographics
NPI:1922149236
Name:PERETTI, JULIO MARIO (BALBSW)
Entity Type:Individual
Prefix:MR
First Name:JULIO
Middle Name:MARIO
Last Name:PERETTI
Suffix:
Gender:M
Credentials:BALBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ALGONAC
Mailing Address - State:MI
Mailing Address - Zip Code:48001-1479
Mailing Address - Country:US
Mailing Address - Phone:810-794-3094
Mailing Address - Fax:586-469-6637
Practice Address - Street 1:21885 DUNHAM RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-1030
Practice Address - Country:US
Practice Address - Phone:586-469-6498
Practice Address - Fax:586-469-6637
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802071126104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker