Provider Demographics
NPI:1205182227
Name:FERISE, STACEY A (LAC, NCC, DRCC)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:A
Last Name:FERISE
Suffix:
Gender:F
Credentials:LAC, NCC, DRCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 SUMMERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-6921
Mailing Address - Country:US
Mailing Address - Phone:732-774-6886
Mailing Address - Fax:732-774-8809
Practice Address - Street 1:705 SUMMERFIELD AVE
Practice Address - Street 2:
Practice Address - City:ASBURY PARK
Practice Address - State:NJ
Practice Address - Zip Code:07712-6921
Practice Address - Country:US
Practice Address - Phone:732-774-6886
Practice Address - Fax:732-774-8809
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00127200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health