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General NPI Number Information
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NPI Number | 1518018019
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Entity Type | Individual
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Provider Name | PHYLLIS ANN PERNA PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 01/13/2007
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Last Update Date | 03/28/2020
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Provider Practice Location Address
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Address Line | 107 HAND AVENUE
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City | ELIZABETHTOWN
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State | NY
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Zip | 12932
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Country | US
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Telephone | 518-962-8884
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Fax |
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Provider Business Mailing Address
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Address Line | 527 STEVENSON RD
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City | WESTPORT
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State | NY
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Zip | 12993-2219
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Country | US
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Telephone | 610-730-5613
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 018491-1
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License Number State | NY
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