MEDICARE: ANTONIA M. PERRY LMSW

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
1	1041C0700X	Clinical Social Worker	6801089711	MI

General Provider Information

NPI Number	:	1780823369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIA M. PERRY LMSW

Provider Business Mailing Address
First Line	:	1048 BIRCHWAY CT
Second Line	:
City	:	SOUTH LYON
State	:	MI
Zip	:	48178-2520
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1048 BIRCHWAY CT
Second Line	:
City	:	SOUTH LYON
State	:	MI
Zip	:	48178-2520
Country	:	US
Telephone Number	:	810-459-0390
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2009
Last Update Date	:	09/14/2023

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