Healthcare Provider Details

I. General information

NPI: 1740100718
Provider Name (Legal Business Name): ANGELA MAY PERRY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MAIN ST
UTICA NY
13501-1236
US

IV. Provider business mailing address

5760 MORRIS RD
MARCY NY
13403-2206
US

V. Phone/Fax

Practice location:
  • Phone: 315-917-1407
  • Fax: 315-792-9578
Mailing address:
  • Phone: 315-525-9364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number128541-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: