Provider Demographics
NPI:1659158368
Name:FERGUSON, NICOLE MARIE (MFT-P)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MFT-P
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:473 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14204-1976
Mailing Address - Country:US
Mailing Address - Phone:716-536-5051
Mailing Address - Fax:
Practice Address - Street 1:2478 GEORGE URBAN BLVD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-2010
Practice Address - Country:US
Practice Address - Phone:716-601-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP118960106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist