Healthcare Provider Details

I. General information

NPI: 1942403209
Provider Name (Legal Business Name): KATHLEEN BARBARA FERREIRA M.A., M.S.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLEEN BARBARA FERREIRA MA, MSED

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 LAFAYETTE RD
WEST BABYLON NY
11704-5814
US

IV. Provider business mailing address

22 LAFAYETTE RD
WEST BABYLON NY
11704-5814
US

V. Phone/Fax

Practice location:
  • Phone: 631-539-9615
  • Fax:
Mailing address:
  • Phone: 631-255-4546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: