Provider Demographics
NPI:1205495595
Name:PERET, MICHAEL J (LMSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:PERET
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:EAGLE LAKE
Mailing Address - State:ME
Mailing Address - Zip Code:04739-0309
Mailing Address - Country:US
Mailing Address - Phone:207-444-5973
Mailing Address - Fax:207-444-5520
Practice Address - Street 1:309 SAINT THOMAS ST STE 213
Practice Address - Street 2:
Practice Address - City:MADAWASKA
Practice Address - State:ME
Practice Address - Zip Code:04756-1278
Practice Address - Country:US
Practice Address - Phone:207-728-3971
Practice Address - Fax:207-728-3970
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MEMC21808104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program