Provider Demographics
NPI:1205056918
Name:JANE E. PERRIN, PH.D.
Entity type:Organization
Organization Name:JANE E. PERRIN, PH.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-299-1115
Mailing Address - Street 1:3608 W FRIENDLY AVE
Mailing Address - Street 2:SUITE #208
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4865
Mailing Address - Country:US
Mailing Address - Phone:336-299-1115
Mailing Address - Fax:336-299-5559
Practice Address - Street 1:3608 W FRIENDLY AVE
Practice Address - Street 2:SUITE #208
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4865
Practice Address - Country:US
Practice Address - Phone:336-299-1115
Practice Address - Fax:336-299-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1102103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC04388OtherBLUE CROSS BLUE SHIELD
NC2812342Medicare ID - Type Unspecified