Healthcare Provider Details

I. General information

NPI: 1801066782
Provider Name (Legal Business Name): FERRANDO CAMPBELL LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 BLUE HILL AVE
DORCHESTER CENTER MA
02124-2828
US

IV. Provider business mailing address

995 BLUE HILL AVENUE ABAC, INC.
BOSTON MA
02124
US

V. Phone/Fax

Practice location:
  • Phone: 617-822-0829
  • Fax: 617-825-7804
Mailing address:
  • Phone: 617-822-0829
  • Fax: 671-825-7804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7591
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: