Provider Demographics
NPI:1972670164
Name:PERREAULT, MILDRED MARY (PHD LCSW PSW)
Entity Type:Individual
Prefix:DR
First Name:MILDRED
Middle Name:MARY
Last Name:PERREAULT
Suffix:
Gender:F
Credentials:PHD LCSW PSW
Other - Prefix:MRS
Other - First Name:MILDRED
Other - Middle Name:MARY
Other - Last Name:MORRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4059 WINDOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606
Mailing Address - Country:US
Mailing Address - Phone:352-666-0066
Mailing Address - Fax:352-666-0066
Practice Address - Street 1:6169 DELTONA BLVD
Practice Address - Street 2:CASTIGNOLI COURT IV
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606
Practice Address - Country:US
Practice Address - Phone:352-592-2828
Practice Address - Fax:352-666-0066
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSW661103T00000X, 1041C0700X
CT3529CT103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical