Healthcare Provider Details

I. General information

NPI: 1063525079
Provider Name (Legal Business Name): JOSEPH THOMAS PERRON PH.D., BCBA-D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 FOURIER DRIVE SUITE #100
MADISON WI
53717-1969
US

IV. Provider business mailing address

1210 FOURIER DRIVE SUITE #100
MADISON WI
53717-1969
US

V. Phone/Fax

Practice location:
  • Phone: 608-662-9327
  • Fax: 608-662-9041
Mailing address:
  • Phone: 608-662-9327
  • Fax: 608-662-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1839-057
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11-140
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: