1861568958 NPI number — MS. AMANDA S PERKINS LCSW

Table of content: MS. AMANDA S PERKINS LCSW (NPI 1861568958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861568958 NPI number — MS. AMANDA S PERKINS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERKINS
Provider First Name:
AMANDA
Provider Middle Name:
S
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLLINS
Provider Other First Name:
AMANDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861568958
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
78 SPRINGDALE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60538-2445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
331-725-0067
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
78 SPRINGDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60538-2445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
331-725-0067
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149017533 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)