MEDICARE: MS. JACQUELINE ANNETTE PERLMUTTER RAS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	RI-P1105241328	CA

General Provider Information

NPI Number	:	1871995167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELINE ANNETTE PERLMUTTER RAS

Provider Business Mailing Address
First Line	:	99 CLEVELAND LN
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-1776
Country	:	US
Telephone Number	:	415-846-8409
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 NELLEN AVE
Second Line	:
City	:	CORTE MADERA
State	:	CA
Zip	:	94925-1104
Country	:	US
Telephone Number	:	415-945-9870
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	09/18/2014

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