Provider Demographics
NPI:1376658906
Name:FERRON, ELIZABETH MARY (LICSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARY
Last Name:FERRON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 ESSEX RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2249
Mailing Address - Country:US
Mailing Address - Phone:612-581-9998
Mailing Address - Fax:320-240-1501
Practice Address - Street 1:5000 W 36TH ST STE 230
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-2771
Practice Address - Country:US
Practice Address - Phone:612-581-9998
Practice Address - Fax:952-516-9224
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3957104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker