Provider Demographics
NPI:1255815577
Name:ST. PERRE, JANE (LCSW)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:ST. PERRE
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 1:1955 W GRANT RD STE 125P
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1471
Mailing Address - Country:US
Mailing Address - Phone:520-429-3673
Mailing Address - Fax:
Practice Address - Street 1:1955 W GRANT RD STE 125P
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-1471
Practice Address - Country:US
Practice Address - Phone:520-429-3673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW10827251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health