Provider Demographics
NPI:1720435837
Name:FERRIMAN, MARK (MA)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:FERRIMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 WESCOM RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON
Mailing Address - State:VT
Mailing Address - Zip Code:05656-9411
Mailing Address - Country:US
Mailing Address - Phone:802-777-4692
Mailing Address - Fax:
Practice Address - Street 1:5 MAIN STREET
Practice Address - Street 2:
Practice Address - City:JOHNSON
Practice Address - State:VT
Practice Address - Zip Code:05656-9411
Practice Address - Country:US
Practice Address - Phone:802-777-4692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0116764101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health