Provider Demographics
NPI:1992867451
Name:PERREGO, KATHLEEN SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:SUSAN
Last Name:PERREGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HARWOOD CT STE 408A
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4157
Mailing Address - Country:US
Mailing Address - Phone:914-472-2204
Mailing Address - Fax:914-472-2412
Practice Address - Street 1:14 HARWOOD CT STE 408A
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4157
Practice Address - Country:US
Practice Address - Phone:914-472-2204
Practice Address - Fax:914-472-2412
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183108-12084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F51587Medicare UPIN
J14761Medicare ID - Type Unspecified