Provider Demographics
NPI:1992964290
Name:PERKINS, PHILIP II
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:PERKINS
Suffix:II
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 1:1970 MEDWAY RD
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04460-3166
Mailing Address - Country:US
Mailing Address - Phone:207-746-5800
Mailing Address - Fax:207-746-5811
Practice Address - Street 1:1970 MEDWAY RD
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:ME
Practice Address - Zip Code:04460-3166
Practice Address - Country:US
Practice Address - Phone:207-746-5800
Practice Address - Fax:207-746-5811
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME428234101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)