Provider Demographics
NPI:1326172370
Name:FERRULLI, MONICA LARAY (MA)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:LARAY
Last Name:FERRULLI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:LARAY
Other - Last Name:BRANDRUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1800 TULLY RD
Mailing Address - Street 2:F
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-2946
Mailing Address - Country:US
Mailing Address - Phone:209-576-1750
Mailing Address - Fax:209-576-1768
Practice Address - Street 1:1800 TULLY RD
Practice Address - Street 2:F
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-2946
Practice Address - Country:US
Practice Address - Phone:209-576-1750
Practice Address - Fax:209-576-1768
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85764101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional