Provider Demographics
NPI:1255353314
Name:PERELSON, MICHAEL R (LMFT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:PERELSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WATER ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2861
Mailing Address - Country:US
Mailing Address - Phone:203-458-0661
Mailing Address - Fax:203-458-6068
Practice Address - Street 1:696 TANNER MARSH RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2107
Practice Address - Country:US
Practice Address - Phone:203-458-0661
Practice Address - Fax:203-458-6068
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000494106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist