Individual
DR. SHANE PERRAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
411 IVY LANE, SUITE 402, GREENBELT, MD 20770
(301) 588-4600
Mailing address
411 IVY LANE, SUITE 402, GREENBELT, MD 20770
(301) 588-4600
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4005
MD
Other
Enumeration date
04/19/2012
Last updated
04/19/2012
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