Provider Demographics
NPI:1073497996
Name:PERDUE, KRISTA YVONNE
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:YVONNE
Last Name:PERDUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 N MAIN ST APT A
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1463
Mailing Address - Country:US
Mailing Address - Phone:050-836-7086
Mailing Address - Fax:
Practice Address - Street 1:331 PAGE ST STE 9
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1172
Practice Address - Country:US
Practice Address - Phone:508-367-0858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW21407511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical