Provider Demographics
NPI:1619703832
Name:PERRY, PAUL JAMES (PHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JAMES
Last Name:PERRY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LUBEC RD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:ME
Mailing Address - Zip Code:04691-3100
Mailing Address - Country:US
Mailing Address - Phone:309-303-2370
Mailing Address - Fax:
Practice Address - Street 1:247 MAIN ST
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654-3606
Practice Address - Country:US
Practice Address - Phone:207-255-4892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool