Provider Demographics
NPI:1568499945
Name:FERM, JOELLEN QUIGLEY (LICSW)
Entity Type:Individual
Prefix:
First Name:JOELLEN
Middle Name:QUIGLEY
Last Name:FERM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 ALLEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MA
Mailing Address - Zip Code:01541-1807
Mailing Address - Country:US
Mailing Address - Phone:978-464-0131
Mailing Address - Fax:
Practice Address - Street 1:586 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-2920
Practice Address - Country:US
Practice Address - Phone:508-842-3100
Practice Address - Fax:508-842-0700
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1022130101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP06563Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER