Provider Demographics
NPI:1083759336
Name:PERRONE, KRISTIN (PHD, HSPP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:PERRONE
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10629 KENSINGTON LN
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-8900
Mailing Address - Country:US
Mailing Address - Phone:317-441-6687
Mailing Address - Fax:
Practice Address - Street 1:3301 W PURDUE AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-6356
Practice Address - Country:US
Practice Address - Phone:765-284-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041593A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist