Provider Demographics
NPI:1902672223
Name:PERREAULT, JENNIFER (MHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PERREAULT
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 JOHNSTON RD # WIND-12
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-4310
Mailing Address - Country:US
Mailing Address - Phone:518-935-5067
Mailing Address - Fax:
Practice Address - Street 1:220 N BALLSTON AVE
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-2533
Practice Address - Country:US
Practice Address - Phone:518-935-5067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18-P126031-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health