Healthcare Provider Details

I. General information

NPI: 1285996546
Provider Name (Legal Business Name): RICHARD EDMUND FERRY M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

696 E SANTA CLARA ST SUITE 204
SAN JOSE CA
95112-1911
US

IV. Provider business mailing address

696 E SANTA CLARA ST SUITE 204
SAN JOSE CA
95112-1911
US

V. Phone/Fax

Practice location:
  • Phone: 408-947-7047
  • Fax: 408-947-7057
Mailing address:
  • Phone: 408-947-7047
  • Fax: 408-947-7057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 13893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: