Provider Demographics
NPI:1982745592
Name:LAURENCE P. PEROTTI, PH.D. P.C.
Entity type:Organization
Organization Name:LAURENCE P. PEROTTI, PH.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:PEROTTI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-310-8864
Mailing Address - Street 1:PO BOX 171185
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-8185
Mailing Address - Country:US
Mailing Address - Phone:210-310-8864
Mailing Address - Fax:210-655-4693
Practice Address - Street 1:9119 CINNAMON HL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-5401
Practice Address - Country:US
Practice Address - Phone:210-558-1102
Practice Address - Fax:210-558-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-2336103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty