Provider Demographics
NPI:1740673748
Name:PERROTTI, ALEXANDER EDWARD (MFTI)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:EDWARD
Last Name:PERROTTI
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 LICHAU RD
Mailing Address - Street 2:
Mailing Address - City:PENNGROVE
Mailing Address - State:CA
Mailing Address - Zip Code:94951-8720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3450 LICHAU RD
Practice Address - Street 2:
Practice Address - City:PENNGROVE
Practice Address - State:CA
Practice Address - Zip Code:94951-8720
Practice Address - Country:US
Practice Address - Phone:510-717-1299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-15
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF75766106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist