=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184124414
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TONI C PERRY, LCSW, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2018
-----------------------------------------------------
Last Update Date | 02/13/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 883 MONTAUK AVE APT 2
-----------------------------------------------------
City | NEW LONDON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06320-4238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-961-5422
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 883 MONTAUK AVE APT 2
-----------------------------------------------------
City | NEW LONDON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06320-4238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-961-5422
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MS. TONI C PERRY
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 860-961-5422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 006984
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------