Provider Demographics
NPI:1295217081
Name:FERRO, MICHAELA MARIE
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:MARIE
Last Name:FERRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 W 7TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2829
Mailing Address - Country:US
Mailing Address - Phone:508-633-5463
Mailing Address - Fax:
Practice Address - Street 1:1266 FURNACE BROOK PKWY STE 100B
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4789
Practice Address - Country:US
Practice Address - Phone:617-433-7699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health