Provider Demographics
NPI:1396450888
Name:PERRY, RAVEN D (LMSW)
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:D
Last Name:PERRY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 YALE ST APT 214
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2590
Mailing Address - Country:US
Mailing Address - Phone:409-225-2653
Mailing Address - Fax:
Practice Address - Street 1:1999 BRYAN ST STE 900
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-3140
Practice Address - Country:US
Practice Address - Phone:888-441-4382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1062291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical