Provider Demographics
NPI:1780997999
Name:PERRY, JANICE MARIE (MFT)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:MARIE
Last Name:PERRY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MISS
Other - First Name:JANICE
Other - Middle Name:MAIRE
Other - Last Name:MOLLICONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3095 INDEPENDENCE DR
Mailing Address - Street 2:BUILDING B SUITE A
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-7629
Mailing Address - Country:US
Mailing Address - Phone:925-443-3434
Mailing Address - Fax:
Practice Address - Street 1:3095 INDEPENDENCE DR
Practice Address - Street 2:BUILDING B SUITE A
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-7629
Practice Address - Country:US
Practice Address - Phone:925-443-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30572101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health