Provider Demographics
NPI:1568025971
Name:FERRELL, REGINALD DEVON II (TESTING TECH)
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:DEVON
Last Name:FERRELL
Suffix:II
Gender:M
Credentials:TESTING TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 LAKEVILLE RD STE 209
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1122
Mailing Address - Country:US
Mailing Address - Phone:516-488-5050
Mailing Address - Fax:516-326-6252
Practice Address - Street 1:410 LAKEVILLE RD STE 209
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1122
Practice Address - Country:US
Practice Address - Phone:516-488-5050
Practice Address - Fax:516-326-6252
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health