Provider Demographics
NPI:1497470900
Name:FERENCHAK, SLOANE (PSYD, MED)
Entity Type:Individual
Prefix:
First Name:SLOANE
Middle Name:
Last Name:FERENCHAK
Suffix:
Gender:F
Credentials:PSYD, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 AINSLIE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1423
Mailing Address - Country:US
Mailing Address - Phone:315-679-2416
Mailing Address - Fax:
Practice Address - Street 1:3355 AINSLIE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1423
Practice Address - Country:US
Practice Address - Phone:315-679-2416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NOtherN/A