Healthcare Provider Details

I. General information

NPI: 1508348947
Provider Name (Legal Business Name): REBECCA PERRY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2018
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MAIN ST STE 16
TORRINGTON CT
06790-5340
US

IV. Provider business mailing address

40 MAIN ST STE 16
TORRINGTON CT
06790-5340
US

V. Phone/Fax

Practice location:
  • Phone: 860-824-1397
  • Fax:
Mailing address:
  • Phone: 860-499-0904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number124587
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11703
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: