Healthcare Provider Details

I. General information

NPI: 1902647167
Provider Name (Legal Business Name): RYLEE L FERGUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 BELMONT ST RM 31
WORCESTER MA
01605-2964
US

IV. Provider business mailing address

PO BOX 655
HOLDEN MA
01520-0655
US

V. Phone/Fax

Practice location:
  • Phone: 508-755-0436
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: