Provider Demographics
NPI:1538907407
Name:PERETTO LA LLC
Entity type:Organization
Organization Name:PERETTO LA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERETTO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-478-7400
Mailing Address - Street 1:20 OTIS ST APT 20F
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5954
Mailing Address - Country:US
Mailing Address - Phone:860-478-7400
Mailing Address - Fax:
Practice Address - Street 1:20 OTIS ST APT 20F
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5954
Practice Address - Country:US
Practice Address - Phone:860-478-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)