Provider Demographics
NPI:1174377220
Name:PERAINO, KELLY ANN (LMFT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:PERAINO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 OLD KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-3723
Mailing Address - Country:US
Mailing Address - Phone:203-858-2636
Mailing Address - Fax:
Practice Address - Street 1:116 OLD KINGS HWY
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-3723
Practice Address - Country:US
Practice Address - Phone:203-858-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003336106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist