Provider Demographics
NPI:1932961679
Name:PERRY, SERENA DOLORES
Entity Type:Individual
Prefix:
First Name:SERENA DOLORES
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 112TH ST SW APT I204
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-7853
Mailing Address - Country:US
Mailing Address - Phone:808-281-0274
Mailing Address - Fax:
Practice Address - Street 1:811 112TH ST SW APT I204
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-7853
Practice Address - Country:US
Practice Address - Phone:808-281-0274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist