Healthcare Provider Details

I. General information

NPI: 1366455040
Provider Name (Legal Business Name): PETER J FERGUSON LMSW, ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5331 PLYMOUTH RD
ANN ARBOR MI
48105-9520
US

IV. Provider business mailing address

2426 SUNNY RIDGE DR
PINCKNEY MI
48169-9244
US

V. Phone/Fax

Practice location:
  • Phone: 734-996-9111
  • Fax: 734-996-1950
Mailing address:
  • Phone: 734-272-7145
  • Fax: 734-996-1950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801081112
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: