Provider Demographics
NPI:1013955129
Name:PERLIN, CYNTHIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:
Last Name:PERLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-2615
Mailing Address - Country:US
Mailing Address - Phone:518-439-6431
Mailing Address - Fax:518-439-6431
Practice Address - Street 1:13 WILLOW DR
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-2615
Practice Address - Country:US
Practice Address - Phone:518-439-6431
Practice Address - Fax:518-439-6431
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0389951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7483401OtherGHI PIN
NY01603805Medicaid
NYN0C06OtherEMPIRE BLUE CROSS
NY55604BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER