1316438765 NPI number — MRS. DAMETRES CHARON PERKINS LICSW

Table of content: MRS. DAMETRES CHARON PERKINS LICSW (NPI 1316438765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316438765 NPI number — MRS. DAMETRES CHARON PERKINS LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERKINS
Provider First Name:
DAMETRES
Provider Middle Name:
CHARON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUTCHINSON
Provider Other First Name:
DAMETRES
Provider Other Middle Name:
CHARON
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316438765
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 DRUM HILL RD STE 311
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHELMSFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01824-1505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-556-0307
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 UNION ST STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01608-1141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-317-2323
Provider Business Practice Location Address Fax Number:
508-519-5619
Provider Enumeration Date:
05/22/2018

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:  120778 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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