Provider Demographics
NPI:1336354224
Name:PERRY, JOAN EC (MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:EC
Last Name:PERRY
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:E
Other - Last Name:CULLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 GAVIN CIR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1368
Mailing Address - Country:US
Mailing Address - Phone:978-744-7037
Mailing Address - Fax:
Practice Address - Street 1:275 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-5404
Practice Address - Country:US
Practice Address - Phone:978-744-7037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1024922104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker