Provider Demographics
NPI:1720742778
Name:PERIN, EDWARD A (PSYD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
Last Name:PERIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 BAYSHORE DR APT 2B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-3859
Mailing Address - Country:US
Mailing Address - Phone:813-362-0073
Mailing Address - Fax:
Practice Address - Street 1:1364 BAYSHORE DR APT 2B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-3859
Practice Address - Country:US
Practice Address - Phone:813-362-0073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.08230103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist