Healthcare Provider Details

I. General information

NPI: 1972670164
Provider Name (Legal Business Name): MILDRED MARY PERREAULT PHD LCSW PSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MILDRED MARY MORRILL LCSW

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6169 DELTONA BLVD CASTIGNOLI COURT IV
SPRING HILL FL
34606
US

IV. Provider business mailing address

4059 WINDOTA AVE
SPRING HILL FL
34606
US

V. Phone/Fax

Practice location:
  • Phone: 352-592-2828
  • Fax: 352-666-0066
Mailing address:
  • Phone: 352-666-0066
  • Fax: 352-666-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSW661
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3529CT
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPSW661
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3529CT
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: