Provider Demographics
NPI:1881090546
Name:PERINI, REBECCA ROSE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ROSE
Last Name:PERINI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 2ND ST # 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4802
Mailing Address - Country:US
Mailing Address - Phone:631-860-4759
Mailing Address - Fax:
Practice Address - Street 1:12 2ND ST # 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-4802
Practice Address - Country:US
Practice Address - Phone:631-860-4759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092256104100000X
NY0861571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker