Healthcare Provider Details

I. General information

NPI: 1336870328
Provider Name (Legal Business Name): CONCETTA FERRAGAMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 MATTHEWS ST
GOSHEN NY
10924-1962
US

IV. Provider business mailing address

27 MATTHEWS ST
GOSHEN NY
10924-1962
US

V. Phone/Fax

Practice location:
  • Phone: 845-294-5888
  • Fax:
Mailing address:
  • Phone: 845-294-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: