Provider Demographics
NPI:1124184296
Name:FERRY, KEVIN FRANCIS (LCSW, LCADC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:FRANCIS
Last Name:FERRY
Suffix:
Gender:M
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 LINDEN LN
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3836
Mailing Address - Country:US
Mailing Address - Phone:212-645-2392
Mailing Address - Fax:212-731-2134
Practice Address - Street 1:167 LINDEN LN
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3836
Practice Address - Country:US
Practice Address - Phone:212-645-2392
Practice Address - Fax:212-731-2134
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00022000101YA0400X
NJ44SC050127001041C0700X
NYRO54907-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02066159Medicaid
NJP20221365OtherOXFORD
NJP20221365OtherOXFORD