MEDICARE: KIMBERLY ANN FERLAUTO MA, NCC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	37PC00449900	NJ

General Provider Information

NPI Number	:	1437406584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANN FERLAUTO MA, NCC, LPC

Provider Business Mailing Address
First Line	:	10 EDISON DR
Second Line	:
City	:	SUMMIT
State	:	NJ
Zip	:	07901-4222
Country	:	US
Telephone Number	:	973-433-6609
Fax Number	:

Provider Business Practice Location Address
First Line	:	786 MOUNTAIN BLVD
Second Line	:	SUITE 102
City	:	WATCHUNG
State	:	NJ
Zip	:	07069-6268
Country	:	US
Telephone Number	:	973-433-6609
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2012
Last Update Date	:	08/08/2012

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Directions to “ KIMBERLY ANN FERLAUTO MA, NCC, LPC” Practice Location

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