Provider Demographics
NPI:1235157728
Name:FERRARO, JERROLD SAMUEL (PHD)
Entity Type:Individual
Prefix:
First Name:JERROLD
Middle Name:SAMUEL
Last Name:FERRARO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 MAIN ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045
Mailing Address - Country:US
Mailing Address - Phone:607-758-3316
Mailing Address - Fax:607-758-3317
Practice Address - Street 1:64 MAIN ST
Practice Address - Street 2:SUITE 213
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045
Practice Address - Country:US
Practice Address - Phone:607-758-3316
Practice Address - Fax:607-758-3317
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015527103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling