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General NPI Number Information
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NPI Number | 1073497996
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Entity Type | Individual
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Provider Name | KRISTA YVONNE PERDUE
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Gender | Female
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 331 PAGE ST STE 9
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City | STOUGHTON
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State | MA
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Zip | 02072-1172
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Country | US
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Telephone | 508-367-0858
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Fax |
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Provider Business Mailing Address
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Address Line | 552 N MAIN ST APT A
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City | MANSFIELD
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State | MA
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Zip | 02048-1463
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Country | US
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Telephone | 50-836-7086
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW2140751
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License Number State | MA
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