Provider Demographics
NPI:1124873252
Name:PERILLO, ALEXA LOUISE (LPAT, LPC)
Entity type:Individual
Prefix:MS
First Name:ALEXA
Middle Name:LOUISE
Last Name:PERILLO
Suffix:
Gender:F
Credentials:LPAT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 RIVER ST STE 302
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5619
Mailing Address - Country:US
Mailing Address - Phone:973-464-7002
Mailing Address - Fax:
Practice Address - Street 1:80 RIVER ST STE 302
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5619
Practice Address - Country:US
Practice Address - Phone:201-409-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC01023000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional