Provider Demographics
NPI:1134288129
Name:FERRIER, MARY JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY JANE
Middle Name:
Last Name:FERRIER
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 1:19 SOUTH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3963
Mailing Address - Country:US
Mailing Address - Phone:207-774-7306
Mailing Address - Fax:
Practice Address - Street 1:19 SOUTH ST
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3963
Practice Address - Country:US
Practice Address - Phone:207-774-7306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS672103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME213190000Medicaid
ME213190000Medicaid