Provider Demographics
NPI:1487001640
Name:PERRIN, ELLIOTT J
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:J
Last Name:PERRIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 SW CATALONIA ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2072
Mailing Address - Country:US
Mailing Address - Phone:772-634-6754
Mailing Address - Fax:772-877-3100
Practice Address - Street 1:1749 SW CATALONIA ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2072
Practice Address - Country:US
Practice Address - Phone:772-634-6754
Practice Address - Fax:772-877-3100
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator