Provider Demographics
NPI:1396867925
Name:FERRONATO, ADAM ANTHONY
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:ANTHONY
Last Name:FERRONATO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 SANTA ANITA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-1611
Mailing Address - Country:US
Mailing Address - Phone:626-246-1766
Mailing Address - Fax:
Practice Address - Street 1:4401 SANTA ANITA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1611
Practice Address - Country:US
Practice Address - Phone:626-246-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CA62858101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health