Provider Demographics
NPI:1902921042
Name:PERJESSY, CAROLINE (LPC)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:PERJESSY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5204 MAHONING AVE
Mailing Address - Street 2:BLDG. 1, SUITE 105
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-1808
Mailing Address - Country:US
Mailing Address - Phone:330-797-8800
Mailing Address - Fax:
Practice Address - Street 1:5204 MAHONING AVE
Practice Address - Street 2:BLDG. 1, SUITE 105
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-1808
Practice Address - Country:US
Practice Address - Phone:330-797-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0602014101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0803312Medicaid
OHCH9284401Medicare ID - Type Unspecified
OH0803312Medicaid