Provider Demographics
NPI:1568513356
Name:FERGUSON-MIZELL, CHRISTINE E (NJ LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:E
Last Name:FERGUSON-MIZELL
Suffix:
Gender:F
Credentials:NJ LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COUNSELING ASSOCIATES CENTRAL
Mailing Address - Street 2:58 BROAD STREET
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736
Mailing Address - Country:US
Mailing Address - Phone:732-528-9904
Mailing Address - Fax:732-833-1481
Practice Address - Street 1:58 BROAD ST
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-2907
Practice Address - Country:US
Practice Address - Phone:732-528-9904
Practice Address - Fax:732-833-1481
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC472051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ135449OtherVALUE OPTIONS PROVIDER ID
NJ203371000OtherMAGELLAN PROVIDER ID
NJ244653OtherMHN PROVIDER ID
NYN12Z9OtherEMPIRE BCBS PROVIDER ID