Provider Demographics
NPI:1508553108
Name:DR. B. J. FERRACCIO, LLC
Entity Type:Organization
Organization Name:DR. B. J. FERRACCIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER / PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FERRACCIO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:724-244-5763
Mailing Address - Street 1:330 EVERGREEN CT
Mailing Address - Street 2:
Mailing Address - City:APOLLO
Mailing Address - State:PA
Mailing Address - Zip Code:15613-1269
Mailing Address - Country:US
Mailing Address - Phone:724-244-5763
Mailing Address - Fax:
Practice Address - Street 1:204 5TH AVENUE
Practice Address - Street 2:STE 402
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-2706
Practice Address - Country:US
Practice Address - Phone:724-244-5763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty