Provider Demographics
NPI:1518700509
Name:FERGUSON, JANE WHITNEY (LICSW)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:WHITNEY
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4970
Mailing Address - Country:US
Mailing Address - Phone:401-444-7398
Mailing Address - Fax:401-444-5715
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4970
Practice Address - Country:US
Practice Address - Phone:401-444-7398
Practice Address - Fax:401-444-5715
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW001981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical