Provider Demographics
NPI:1700534740
Name:PERNA, BRITTNY (LSW)
Entity Type:Individual
Prefix:
First Name:BRITTNY
Middle Name:
Last Name:PERNA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BORMAN DR
Mailing Address - Street 2:
Mailing Address - City:WANAQUE
Mailing Address - State:NJ
Mailing Address - Zip Code:07465-1051
Mailing Address - Country:US
Mailing Address - Phone:862-221-5706
Mailing Address - Fax:
Practice Address - Street 1:20 VANDERHOOF AVE
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3148
Practice Address - Country:US
Practice Address - Phone:973-586-5243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06449200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SL06449200Medicaid