Provider Demographics
NPI:1588972392
Name:PERRY, KATHERINE JANE (LCPC, NCC, DCC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JANE
Last Name:PERRY
Suffix:
Gender:F
Credentials:LCPC, NCC, DCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MAIN ST STE 1408A
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-3518
Mailing Address - Country:US
Mailing Address - Phone:207-650-7528
Mailing Address - Fax:866-929-0240
Practice Address - Street 1:110 MAIN ST STE 1408A
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3518
Practice Address - Country:US
Practice Address - Phone:207-650-7528
Practice Address - Fax:866-929-0240
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC4002101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health