Healthcare Provider Details

I. General information

NPI: 1740127737
Provider Name (Legal Business Name): MORIAH LEIGHANN FERGUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RETREAT AVE
HARTFORD CT
06106-3310
US

IV. Provider business mailing address

18 WESTFIELD ST
MANCHESTER CT
06042-2337
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-7649
  • Fax:
Mailing address:
  • Phone: 860-436-1463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: