Provider Demographics
NPI:1659404549
Name:FERRARI, GERARD EDWARD (MA, CAGS)
Entity Type:Individual
Prefix:MR
First Name:GERARD
Middle Name:EDWARD
Last Name:FERRARI
Suffix:
Gender:M
Credentials:MA, CAGS
Other - Prefix:MR
Other - First Name:GERARD
Other - Middle Name:EDWARD
Other - Last Name:FERRARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CAGS
Mailing Address - Street 1:111 LOON POND RD
Mailing Address - Street 2:
Mailing Address - City:GILMANTON
Mailing Address - State:NH
Mailing Address - Zip Code:03237-5114
Mailing Address - Country:US
Mailing Address - Phone:603-267-8829
Mailing Address - Fax:
Practice Address - Street 1:121 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1905
Practice Address - Country:US
Practice Address - Phone:603-759-9240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH657103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1310OtherSTATE LIC. AS PSYCHOLOGIT
NH657OtherSTATE LIC AS PSYCHOLOGIST
22252OtherNAT.REGISTER PSYCHOLOGY
NH30420791Medicaid
NHNH2272Medicare ID - Type UnspecifiedPSYCHOLOGIST