Healthcare Provider Details

I. General information

NPI: 1487440624
Provider Name (Legal Business Name): MARK FERRY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 MAIN ST STE 4
MONROE CT
06468-2830
US

IV. Provider business mailing address

52 OBTUSE RD S
BROOKFIELD CT
06804-3626
US

V. Phone/Fax

Practice location:
  • Phone: 475-219-0769
  • Fax:
Mailing address:
  • Phone: 203-240-0771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: