Provider Demographics
NPI:1982715983
Name:PERRY, JUNE MARY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUNE
Middle Name:MARY
Last Name:PERRY
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 1:2236 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-6577
Mailing Address - Country:US
Mailing Address - Phone:631-682-6008
Mailing Address - Fax:
Practice Address - Street 1:510 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1152
Practice Address - Country:US
Practice Address - Phone:516-437-6050
Practice Address - Fax:516-437-6304
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071791-1104100000X
NY076904-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker