Provider Demographics
NPI:1952495442
Name:FERRELL, DONALD RAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:RAY
Last Name:FERRELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 GROUSE LN
Mailing Address - Street 2:
Mailing Address - City:DORSET
Mailing Address - State:VT
Mailing Address - Zip Code:05251-9608
Mailing Address - Country:US
Mailing Address - Phone:802-867-4469
Mailing Address - Fax:802-867-4469
Practice Address - Street 1:46 GROUSE LN
Practice Address - Street 2:
Practice Address - City:DORSET
Practice Address - State:VT
Practice Address - Zip Code:05251-9608
Practice Address - Country:US
Practice Address - Phone:802-867-4469
Practice Address - Fax:802-867-4469
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0000215103TP0814X
NY0000216103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0000215OtherVERMONT STATE LICENSE
NY0000216OtherNEW YORK STATE LICENSE