Provider Demographics
NPI:1023356722
Name:MARTIN-FERGERSTROM, DEBRA ANN
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANN
Last Name:MARTIN-FERGERSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10928
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-5928
Mailing Address - Country:US
Mailing Address - Phone:808-937-6737
Mailing Address - Fax:
Practice Address - Street 1:400 KINOOLE ST, #306
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-1812
Practice Address - Country:US
Practice Address - Phone:808-937-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst