Provider Demographics
NPI:1487992509
Name:PERNA, LISA JAYNE (MA)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:JAYNE
Last Name:PERNA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 OAK ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-4414
Mailing Address - Country:US
Mailing Address - Phone:774-275-8791
Mailing Address - Fax:
Practice Address - Street 1:108 GROVE ST FL 2
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2651
Practice Address - Country:US
Practice Address - Phone:774-275-8791
Practice Address - Fax:508-409-6366
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13520101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health