Healthcare Provider Details

I. General information

NPI: 1285292730
Provider Name (Legal Business Name): JONATHAN FERGUSON MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 FORUM PL STE 7
WEST PALM BEACH FL
33401-2330
US

IV. Provider business mailing address

1639 FORUM PL STE 7
WEST PALM BEACH FL
33401-2330
US

V. Phone/Fax

Practice location:
  • Phone: 561-712-8821
  • Fax:
Mailing address:
  • Phone: 561-712-8821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: