Provider Demographics
NPI:1124038153
Name:FERMA, ERIN KELLY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:KELLY
Last Name:FERMA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 5TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-6964
Mailing Address - Country:US
Mailing Address - Phone:619-231-2668
Mailing Address - Fax:619-231-4133
Practice Address - Street 1:614 5TH AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-6964
Practice Address - Country:US
Practice Address - Phone:619-231-2668
Practice Address - Fax:619-231-4133
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20990103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical