Provider Demographics
NPI:1063528685
Name:PERROTTI, PAUL THOMAS (MA LPC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:THOMAS
Last Name:PERROTTI
Suffix:
Gender:M
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 CINCINNATI - COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-1209
Mailing Address - Country:US
Mailing Address - Phone:513-779-9955
Mailing Address - Fax:513-779-9955
Practice Address - Street 1:9900 CINCINNATI - COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-1209
Practice Address - Country:US
Practice Address - Phone:513-779-9955
Practice Address - Fax:513-779-9955
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0001706103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1218066OtherCHA