Healthcare Provider Details

I. General information

NPI: 1730618323
Provider Name (Legal Business Name): CAMMIE MARIE PERRETTA MSW, LISCW, PMH-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9018 CAMPUS GLEN DR NE
LACEY WA
98516-3898
US

IV. Provider business mailing address

9018 CAMPUS GLEN DR NE
LACEY WA
98516-3898
US

V. Phone/Fax

Practice location:
  • Phone: 360-328-1809
  • Fax:
Mailing address:
  • Phone: 360-328-1809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number60705519
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: