Provider Demographics
NPI:1144378266
Name:FERENTINO, SHEILA CONNOLLY (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:CONNOLLY
Last Name:FERENTINO
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 1:1805 215TH ST
Mailing Address - Street 2:APT.2B
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2155
Mailing Address - Country:US
Mailing Address - Phone:718-224-2377
Mailing Address - Fax:
Practice Address - Street 1:1805 215TH ST
Practice Address - Street 2:APT.2B
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2155
Practice Address - Country:US
Practice Address - Phone:718-224-2377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011520103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral