Provider Demographics
NPI:1326379793
Name:FERRARO, JACQUELINE THERESA (DMH)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:THERESA
Last Name:FERRARO
Suffix:
Gender:F
Credentials:DMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W 75TH ST
Mailing Address - Street 2:#1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2060
Mailing Address - Country:US
Mailing Address - Phone:212-496-0442
Mailing Address - Fax:
Practice Address - Street 1:15 W 75TH ST
Practice Address - Street 2:#1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2060
Practice Address - Country:US
Practice Address - Phone:212-496-0442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-24
Last Update Date:2010-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010382103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical