Individual
KELLY A PERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
5 HEIDI ST, SPRINGVALE, ME 04083-1869
(207) 718-7084
Mailing address
PO BOX 259, SPRINGVALE, ME 04083-0259
(207) 718-7084
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
MC10603
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
329230099
—
ME
Enumeration date
08/05/2006
Last updated
03/31/2021
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