Provider Demographics
NPI:1740506021
Name:PERRY, KATHERINE R (MSW, BHP)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:R
Last Name:PERRY
Suffix:
Gender:F
Credentials:MSW, BHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 FRONTAGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4638
Mailing Address - Country:US
Mailing Address - Phone:520-452-9784
Mailing Address - Fax:520-452-0814
Practice Address - Street 1:1939 FRONTAGE RD STE A
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4638
Practice Address - Country:US
Practice Address - Phone:520-452-9784
Practice Address - Fax:520-452-0814
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW 12962104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker