Provider Demographics
NPI:1104369008
Name:FERRER, JENNIFER ROSE (MA, BCBA, LBA, QMHP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:FERRER
Suffix:
Gender:F
Credentials:MA, BCBA, LBA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10535 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-4416
Mailing Address - Country:US
Mailing Address - Phone:703-492-2686
Mailing Address - Fax:866-499-8840
Practice Address - Street 1:10535 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-4416
Practice Address - Country:US
Practice Address - Phone:703-492-2686
Practice Address - Fax:866-499-8840
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000884103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA270766437Medicaid