Provider Demographics
NPI:1174155790
Name:FERGUSON, HEATHER CHARL
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:CHARL
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W 12TH ST APT 1G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8557
Mailing Address - Country:US
Mailing Address - Phone:212-254-6265
Mailing Address - Fax:212-254-6265
Practice Address - Street 1:15 W 12TH ST APT 1G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8557
Practice Address - Country:US
Practice Address - Phone:212-254-6265
Practice Address - Fax:212-254-6265
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYO384231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical