Provider Demographics
NPI:1972685485
Name:PERLMAN, LAWRENCE MARK (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:MARK
Last Name:PERLMAN
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 1:2339 TALL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2219
Mailing Address - Country:US
Mailing Address - Phone:734-996-9939
Mailing Address - Fax:
Practice Address - Street 1:342 S ASHLEY ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1351
Practice Address - Country:US
Practice Address - Phone:734-846-7949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011693103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical