Provider Demographics
NPI:1497946487
Name:FERGIONE, EUGENE THOMAS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:THOMAS
Last Name:FERGIONE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GINA LN
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:CT
Mailing Address - Zip Code:06447-1255
Mailing Address - Country:US
Mailing Address - Phone:860-295-8768
Mailing Address - Fax:
Practice Address - Street 1:20 GINA LN
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447-1255
Practice Address - Country:US
Practice Address - Phone:860-295-8768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000316104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker