| Doctor Name: | ETHAN PERRY |
| NPI Number: | 1124432752 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMHC, CASAC |
| License Number: | 18 004757 |
| Business Practice Address: | 63 Channingville Rd Wappingers Falls, NY - 125902338 |
| Business Phone Number: | 9177336009 |
| Business Fax Number: | |
| Mailing Address: | 63 Channingville Rd., WAPPINGERS FALLS |
| State: | NY |
| Postal Code: | 12590 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 06/11/2014 |
| NPI Last Update Date: | 06/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 18 004757 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |