Provider Demographics
NPI:1942403209
Name:FERREIRA, KATHLEEN BARBARA (MA, MSED)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:BARBARA
Last Name:FERREIRA
Suffix:
Gender:F
Credentials:MA, MSED
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:BARBARA
Other - Last Name:FERREIRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MSED
Mailing Address - Street 1:22 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-5814
Mailing Address - Country:US
Mailing Address - Phone:631-255-4546
Mailing Address - Fax:
Practice Address - Street 1:22 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-5814
Practice Address - Country:US
Practice Address - Phone:631-539-9615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator