Provider Demographics
NPI:1700283439
Name:FERRITER, MARK (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:FERRITER
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 KENSINGTON AVE
Mailing Address - Street 2:STE 208
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5670
Mailing Address - Country:US
Mailing Address - Phone:406-461-6784
Mailing Address - Fax:
Practice Address - Street 1:800 KENSINGTON AVE
Practice Address - Street 2:STE 208
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5670
Practice Address - Country:US
Practice Address - Phone:406-461-6784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCSW-LIC-88721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical