Provider Demographics
NPI:1013762012
Name:FERGUSON, CRAIGIRITA RANDIANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:CRAIGIRITA
Middle Name:RANDIANNE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 SOMERSET DR APT 106
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33311-8502
Mailing Address - Country:US
Mailing Address - Phone:954-673-7727
Mailing Address - Fax:
Practice Address - Street 1:2630 W BROWARD BLVD STE 203-1235
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1314
Practice Address - Country:US
Practice Address - Phone:954-673-7727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW22873101YS0200X, 104100000X, 101YA0400X, 101YM0800X, 101YP2500X, 1041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool