Provider Demographics
NPI:1891805016
Name:FERRANDINO, GINA M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:M
Last Name:FERRANDINO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:FERRANDINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:27485 THREE MILE POINT RD
Mailing Address - Street 2:
Mailing Address - City:CHAUMONT
Mailing Address - State:NY
Mailing Address - Zip Code:13622-2187
Mailing Address - Country:US
Mailing Address - Phone:609-774-3559
Mailing Address - Fax:
Practice Address - Street 1:27485 THREE MILE POINT RD
Practice Address - Street 2:
Practice Address - City:CHAUMONT
Practice Address - State:NY
Practice Address - Zip Code:13622-2187
Practice Address - Country:US
Practice Address - Phone:609-774-3559
Practice Address - Fax:315-772-2558
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00364100103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6941206Medicaid
NJ886631Medicare ID - Type Unspecified