Provider Demographics
NPI:1851472674
Name:FERRISE, FRANK R (PSYD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:R
Last Name:FERRISE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 W MOUNT PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1609
Mailing Address - Country:US
Mailing Address - Phone:973-422-9888
Mailing Address - Fax:973-422-9840
Practice Address - Street 1:629 W MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1609
Practice Address - Country:US
Practice Address - Phone:973-422-9888
Practice Address - Fax:973-422-9840
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJS101257103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110109Medicare ID - Type Unspecified