Provider Demographics
NPI:1356402572
Name:PERKINS, ANNIE PW (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:PW
Last Name:PERKINS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 MELARKEY ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-3178
Mailing Address - Country:US
Mailing Address - Phone:775-304-4849
Mailing Address - Fax:775-623-3282
Practice Address - Street 1:530 MELARKEY ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-3178
Practice Address - Country:US
Practice Address - Phone:775-304-4849
Practice Address - Fax:775-623-3282
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2011-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4170-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV36494Medicare PIN