Provider Demographics
NPI:1831601913
Name:PETER PERROTTA MS., LPC., LADC., LLC
Entity type:Organization
Organization Name:PETER PERROTTA MS., LPC., LADC., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:PERROTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, LADC
Authorized Official - Phone:860-751-9125
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-0055
Mailing Address - Country:US
Mailing Address - Phone:860-751-9125
Mailing Address - Fax:
Practice Address - Street 1:50 ALBANY TPKE STE 3010
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2555
Practice Address - Country:US
Practice Address - Phone:860-751-9125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT44.001162261QM0801X
CT3284261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)