1558646646 NPI number — MRS. JENNIFER NICOLE PERRY LCSW

Table of content: MRS. JENNIFER NICOLE PERRY LCSW (NPI 1558646646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558646646 NPI number — MRS. JENNIFER NICOLE PERRY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERRY
Provider First Name:
JENNIFER
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
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:
GLASS
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558646646
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
740 S LIMESTONE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40536-0284
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-323-6228
Provider Business Mailing Address Fax Number:
859-323-3795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
740 N LIMESTONE
Provider Second Line Business Practice Location Address:
J420
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40508-1683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-323-6228
Provider Business Practice Location Address Fax Number:
859-323-3795
Provider Enumeration Date:
10/20/2011

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:  3411 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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