Provider Demographics
NPI:1598278525
Name:PEROTTI, SELENA LAUREN (LICSW)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:LAUREN
Last Name:PEROTTI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 LOCKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-2816
Mailing Address - Country:US
Mailing Address - Phone:413-358-8671
Mailing Address - Fax:
Practice Address - Street 1:31 HALL DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2751
Practice Address - Country:US
Practice Address - Phone:413-256-8561
Practice Address - Fax:866-644-0869
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1259651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical