Provider Demographics
NPI:1568090264
Name:FERACO, MICHELE ASHLEY
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ASHLEY
Last Name:FERACO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3410
Mailing Address - Country:US
Mailing Address - Phone:631-807-9289
Mailing Address - Fax:
Practice Address - Street 1:16 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3410
Practice Address - Country:US
Practice Address - Phone:631-807-9289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-29
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician