Provider Demographics
NPI:1306040969
Name:PERINO, LAURA (PCC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:PERINO
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-1127
Mailing Address - Country:US
Mailing Address - Phone:419-878-5392
Mailing Address - Fax:
Practice Address - Street 1:1200 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1406
Practice Address - Country:US
Practice Address - Phone:419-662-5555
Practice Address - Fax:419-662-5547
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 00022990101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health