Healthcare Provider Details

I. General information

NPI: 1417904426
Provider Name (Legal Business Name): JEAN M. FERROVIA LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SPRINGS ROAD 518/136G
BEDFORD MA
01730
US

IV. Provider business mailing address

317 CALIFORNIA ST
NEWTON MA
02458-1052
US

V. Phone/Fax

Practice location:
  • Phone: 781-687-2511
  • Fax: 781-687-2018
Mailing address:
  • Phone: 781-687-2511
  • Fax: 781-687-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number102858
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: