Provider Demographics
NPI:1629359377
Name:FERA, SHANNON JANE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:JANE
Last Name:FERA
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 1:25 E NORTHFIELD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4531
Mailing Address - Country:US
Mailing Address - Phone:973-462-2295
Mailing Address - Fax:
Practice Address - Street 1:380 MAIN ST
Practice Address - Street 2:UNIT 37
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2113
Practice Address - Country:US
Practice Address - Phone:973-462-2295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst