Provider Demographics
NPI:1316438765
Name:PERKINS, DAMETRES CHARON (LICSW)
Entity type:Individual
Prefix:MRS
First Name:DAMETRES
Middle Name:CHARON
Last Name:PERKINS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:DAMETRES
Other - Middle Name:CHARON
Other - Last Name:HUTCHINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:119 DRUM HILL RD STE 311
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1505
Mailing Address - Country:US
Mailing Address - Phone:508-556-0307
Mailing Address - Fax:
Practice Address - Street 1:25 UNION ST STE 3
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1141
Practice Address - Country:US
Practice Address - Phone:508-317-2323
Practice Address - Fax:508-519-5619
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1207781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical