Provider Demographics
NPI:1528723434
Name:PERKOWSKI-MARCANTONIO, AMEE
Entity type:Individual
Prefix:
First Name:AMEE
Middle Name:
Last Name:PERKOWSKI-MARCANTONIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-0513
Mailing Address - Country:US
Mailing Address - Phone:203-427-5041
Mailing Address - Fax:
Practice Address - Street 1:92 PRINCE ST
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4122
Practice Address - Country:US
Practice Address - Phone:203-427-5041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2760106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty