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Individual

DR. MICHAEL JAMES PERLOTTO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PSY.D.

Contact information

Practice address
646 MAIN ST, PORT JEFFERSON, NY 11777-2235
(631) 689-1462
Mailing address
PO BOX 430, STONY BROOK, NY 11790-0430
(631) 689-1462

Taxonomy

Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
016211
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0110537
VALUE OPTIONS PROVIDER #
NY
Enumeration date
01/10/2007
Last updated
07/08/2007
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