Provider Demographics
NPI:1831247055
Name:PERROTTA, PETER (PHD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:PERROTTA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 BUTTERFIELD RD STE 101N
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-3405
Mailing Address - Country:US
Mailing Address - Phone:630-586-0900
Mailing Address - Fax:630-586-9990
Practice Address - Street 1:2625 BUTTERFIELD RD STE 101N
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523
Practice Address - Country:US
Practice Address - Phone:630-586-0900
Practice Address - Fax:630-586-9990
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2018-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-003266103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist