Healthcare Provider Details

I. General information

NPI: 1326172370
Provider Name (Legal Business Name): MONICA LARAY FERRULLI MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONICA LARAY BRANDRUP MA

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 TULLY RD F
MODESTO CA
95350-2946
US

IV. Provider business mailing address

1800 TULLY RD F
MODESTO CA
95350-2946
US

V. Phone/Fax

Practice location:
  • Phone: 209-576-1750
  • Fax: 209-576-1768
Mailing address:
  • Phone: 209-576-1750
  • Fax: 209-576-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number85764
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: