Provider Demographics
NPI:1528715844
Name:PERRY, DONDRE DEVON (MS, LBS)
Entity type:Individual
Prefix:
First Name:DONDRE
Middle Name:DEVON
Last Name:PERRY
Suffix:
Gender:M
Credentials:MS, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 MUNICIPAL DR STE 530
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-8985
Mailing Address - Country:US
Mailing Address - Phone:484-335-6100
Mailing Address - Fax:484-335-6104
Practice Address - Street 1:630 MUNICIPAL DR STE 530
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-8985
Practice Address - Country:US
Practice Address - Phone:484-335-6100
Practice Address - Fax:484-335-6104
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH005824103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst