Provider Demographics
NPI:1922302413
Name:PERRI, BENITO MICHAEL (PHG LCSW)
Entity Type:Individual
Prefix:DR
First Name:BENITO
Middle Name:MICHAEL
Last Name:PERRI
Suffix:
Gender:M
Credentials:PHG LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MERCER STREET APT 21L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-6739
Mailing Address - Country:US
Mailing Address - Phone:212-387-0181
Mailing Address - Fax:
Practice Address - Street 1:300 MERCER ST APT 21L
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6730
Practice Address - Country:US
Practice Address - Phone:212-387-0181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCSW011641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical