Provider Demographics
NPI:1245339035
Name:PERRY, MILDRED LEE (EDD)
Entity type:Individual
Prefix:DR
First Name:MILDRED
Middle Name:LEE
Last Name:PERRY
Suffix:
Gender:F
Credentials:EDD
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 4734
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20775-0734
Mailing Address - Country:US
Mailing Address - Phone:240-893-4100
Mailing Address - Fax:301-843-4788
Practice Address - Street 1:6201 GREENBELT RD
Practice Address - Street 2:SUITE U- 4
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2354
Practice Address - Country:US
Practice Address - Phone:240-893-4100
Practice Address - Fax:301-843-4788
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0041101YM0800X
DCPRC237101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health