Provider Demographics
NPI:1053724906
Name:PERRY, LORRAINE JEANETTE (PHD)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:JEANETTE
Last Name:PERRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5497 DENNIS RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-3325
Mailing Address - Country:US
Mailing Address - Phone:315-720-2029
Mailing Address - Fax:
Practice Address - Street 1:21 PRINCETON PL
Practice Address - Street 2:SUITE 100
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2396
Practice Address - Country:US
Practice Address - Phone:716-539-9232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020587-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist