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General NPI Number Information
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NPI Number | 1568513356
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Entity Type | Individual
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Provider Name | CHRISTINE E FERGUSON-MIZELL NJ LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 09/21/2012
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Provider Practice Location Address
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Address Line | 58 BROAD ST
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City | MANASQUAN
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State | NJ
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Zip | 08736-2907
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Country | US
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Telephone | 732-528-9904
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Fax | 732-833-1481
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Provider Business Mailing Address
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Address Line | COUNSELING ASSOCIATES CENTRAL 58 BROAD STREET
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City | MANASQUAN
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State | NJ
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Zip | 08736
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Country | US
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Telephone | 732-528-9904
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Fax | 732-833-1481
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SC47205
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License Number State | NJ
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