Provider Demographics
NPI:1295271294
Name:FERRARO, JAMIE PETERSEN (LCSW)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:PETERSEN
Last Name:FERRARO
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 1:615 N 18TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-3413
Mailing Address - Country:US
Mailing Address - Phone:765-423-5361
Mailing Address - Fax:
Practice Address - Street 1:615 N 18TH ST STE 101
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3413
Practice Address - Country:US
Practice Address - Phone:765-423-5361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical