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NPI Code Detail

MEDICARE: MR. SIDNEY TYRONE PERKINS CDCA

MEDICARE: MR. SIDNEY TYRONE PERKINS CDCA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor165712OH

General Provider Information

NPI Number : 1568964906
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SIDNEY TYRONE PERKINS CDCA
Provider Business Mailing Address
First Line : 16321 LORAIN AVE APT 504
Second Line :
City : CLEVELAND
State : OH
Zip : 44111-5548
Country : US
Telephone Number : 216-391-0977
Fax Number : 216-391-0978
Provider Business Practice Location Address
First Line : 3030 EUCLID AVE STE 312
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-2518
Country : US
Telephone Number : 216-391-0977
Fax Number : 216-391-0978
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2018
Last Update Date : 03/01/2018

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Directions to “ MR. SIDNEY TYRONE PERKINS CDCA” Practice Location

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