MEDICARE: DR. B. J. FERRACCIO, LLC

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	103TC0700X	Clinical Psychologist
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1508553108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. B. J. FERRACCIO, LLC

Provider Business Mailing Address
First Line	:	330 EVERGREEN CT
Second Line	:
City	:	APOLLO
State	:	PA
Zip	:	15613-1269
Country	:	US
Telephone Number	:	724-244-5763
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 5TH AVENUE
Second Line	:	STE 402
City	:	PITTSBURGH
State	:	PA
Zip	:	15222-2706
Country	:	US
Telephone Number	:	724-244-5763
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER / PSYCHOLOGIST
Name	:	DR. BRIAN JOSEPH FERRACCIO
Credential	:	PSY.D.
Telephone Number	:	724-244-5763

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	06/30/2023

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