MEDICARE: PERRY PSYCHIATRY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1093181414	OTHER	MA	NPI

General Provider Information

NPI Number	:	1285198432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERRY PSYCHIATRY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 52
Second Line	:
City	:	HOLDEN
State	:	MA
Zip	:	01520-0052
Country	:	US
Telephone Number	:	508-241-4248
Fax Number	:

Provider Business Practice Location Address
First Line	:	1161 MAIN ST FL 2
Second Line	:
City	:	HOLDEN
State	:	MA
Zip	:	01520-1222
Country	:	US
Telephone Number	:	508-241-4248
Fax Number	:	978-560-0096

Authorized Official
Title or Position	:	PSYCHIATRIC CNP/ OWNER
Name	:	ERICA PERRY
Credential	:	PSYCHIATRIC CNP
Telephone Number	:	508-733-7398

Provider Enumeration Date	:	01/22/2019
Last Update Date	:	11/09/2023

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