=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649591025
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONICA YVETTE PERRY LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2010
-----------------------------------------------------
Last Update Date | 01/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 165 N 4TH ST
-----------------------------------------------------
City | LAKE MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32746-2954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-473-2953
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 165 SABAL PALM DR STE 101
-----------------------------------------------------
City | LONGWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32779-2591
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-473-2953
-----------------------------------------------------
Fax | 407-869-1006
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MT2158
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------