Provider Demographics
NPI:1972392264
Name:PERITO, MCKENNA (RBT)
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:
Last Name:PERITO
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6934
Mailing Address - Country:US
Mailing Address - Phone:803-394-5619
Mailing Address - Fax:803-339-1907
Practice Address - Street 1:3401 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6934
Practice Address - Country:US
Practice Address - Phone:803-394-5619
Practice Address - Fax:803-339-1907
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician